Dr Campbell Gourlay, at the University of Kent, has developed a way to help patients find their voice again after they have their larynx removed. Using bioscience, the valve they use to breathe and speak can last for years and gives them more freedom, for longer.
Category
🗞
NewsTranscript
00:00Think about the way you eat, breathe and speak. It's not something many people truly think
00:23about but for many they do all of this with the help of a voice prosthesis. Your larynx
00:31is where your vocal cords are, so when someone has a total laryngectomy, meaning their larynx
00:35is removed, they can no longer speak. The air that comes from their lungs no longer
00:40comes out through their mouth, it comes out through a hole in their throat called a stoma.
00:46So when patients get fitted with a prosthesis it involves the small device being put in
00:50the trachea. This diverts air from the lungs through a valve and into the esophagus, otherwise
00:56known as your food pipe. It then puts the air back into your mouth. Through vibrations
01:02created and training with a speech and language therapist, patients can learn to speak again.
01:08But of course you have to eat and with that comes bacteria and microorganisms. The bacteria
01:14in your mouth can stick to something called biofilm at the top of the device and this
01:20build up can stop it from working. There are serious potential consequences if this
01:24voice prosthesis becomes infected, so preventing this biofilm from forming was the key to helping
01:30patients. Almost a decade ago here at the University of Kent, Dr Campbell Gourlay helped
01:37to develop a way to keep the valve clean. Alongside Kent Cancer Trust, the Biosciences
01:43team joined forces with other scientists and clinicians and they found that the voice prosthesis
01:48would frequently fail because of a yeast called candida albicans. So they developed
01:54something called an antifungal treatment strategy to try and extend the life of the voice prosthesis.
01:59This would mean that patients would get their valve changed less, but also hospital visits
02:03would be dramatically reduced. So to go into a little bit more detail is Dr Campbell Gourlay.
02:10I went to visit him at his lab at the University of Kent to see what the voice prosthesis looks
02:15like, but also see how something so simple can drastically help the lives of hospital
02:21staff and patients. So I'm a cell biologist and a microbiologist, which means that I'm
02:28interested in the study of microorganisms. We were contacted by the local hospital trust
02:33by the speech and language therapist there, who was interested in trying to improve the
02:38quality of life of her patients who were fitted with one of these devices. This little thing
02:43here, which is called a voice prosthesis or speaking valve, is applied to patients
02:48when they have had their larynx removed. And this is typically patients who've had advanced
02:54laryngeal cancer. So alongside the antifungal gel is almost like a toothbrush that you would
02:59use for your teeth. Explain a little bit more about how patients would use that. Yeah, of
03:03course, you're quite right. It is exactly like brushing your teeth. And they've simply
03:07brushed their prosthetic twice a day by inserting the brush that's provided by the manufacturer.
03:13And it quite nicely fits in and cleans the valve. So the application of the antifungal
03:19will help to prevent the biofilm from forming on the prosthetic. And just as cleaning your
03:24teeth would stop plaque buildup, which is a biofilm, you stop the biofilm from building
03:30up on the prosthetic. For much longer, just to give you an idea of the timescale, patients
03:36would sometimes have to come in every two weeks to have their valve changed. And so
03:41our patients that are on our pathway would typically be anywhere between six months to
03:48two years before they would need a replacement instead of two weeks. Okay, so the numbers
03:52are impressive. But what about the everyday reality of a patient who's going through the
03:56treatment pathway? I went to Kent and Canterbury Hospital to meet Rich, who was diagnosed with
04:01cancer in 2008. He had to have his larynx removed along with radiotherapy as part of
04:07his treatment, and then years later, became a part of the research. He met me with his
04:13wife Jenny to chat about what the prosthesis is really like day to day, and how their lives
04:17have changed. Getting that news must have been, well, terrifying, I guess.
04:23One of my fingers. Yeah. Can't deny that. No. He was losing his voice for quite a while.
04:33Couldn't hear him, it was a whisper. He decided to go to the doctors and then everybody was
04:38very quick to put Cancer Pathways into operation to find out what was going on. And he had
04:45a total laryngectomy with reconstructive surgery of his throat. So he doesn't breathe at all
04:52through his nose, it's all through that valve in his throat. Later on, they put the speech
04:57valve in, and then obviously from there, he learnt how to talk with a valve and how to
05:05cough properly by taking in some breaths or something, wasn't it?
05:09So tell me a little bit about your journey from then to now.
05:11The valve that goes in my throat, had to have that changed quite often, originally.
05:20When he started, it was a maximum three months he would go, but generally it was around six
05:26weeks and him changing that valve, and that trauma as well, keep changing that valve in
05:31his throat.
05:48Has it, you know, helped and changed your life a little bit, knowing that you don't
05:51have to worry as frequently?
05:56At the moment, anyway, most of the times it would.
06:00Was it strange to kind of learn how to talk again, in a way?
06:04Yes, quite, yeah, the greatest time, originally.
06:08Language time, so very, very important.
06:13Absolutely, you wouldn't be able to speak to people properly, would you? You wouldn't
06:18be able to use your phone. Yeah, you'd just be joining in, but not really there.
06:25Layla Williams is a speech and language therapist.
06:28She works with many patients who have had the device fitted and can be with them on
06:32their journey for decades, helping them to speak in a new way and adapt to this monumental
06:38change in their lives.
06:39She is one of the few who knows the impact that having a voice prosthesis fitted can
06:43have on patients and hospitals.
06:46This device, this treatment helps people to speak and eat and breathe.
06:51So how impactful is it and how important is it?
06:54Because, you know, people lose their voice in a way and they have to then relearn how
06:59to speak.
06:59Absolutely.
07:00So immediately after surgery, patients don't have a voice at all.
07:05And until a voice prosthesis or a speaking valve is fitted, they may need to use alternative
07:10means of communication.
07:11So that could be mouthing, writing things down.
07:15And then once they are given the opportunity to have a voice again, it can actually be
07:19quite emotional.
07:20And we find sometimes that patients are quite tearful and they can tell their loved ones
07:26things for the first time they haven't been able to say for a number of weeks sometimes.
07:31What kind of specific things do you do with these patients to help them recover and move
07:36on with their lives?
07:37So getting the technique right for producing voice is really important.
07:43To be able to divert the air that's coming normally in and out of the stoma when a patient
07:48is breathing, we need to teach them how to divert that air through the speaking valve.
07:52So that means covering over the stoma, the breathing hole in the front of the neck.
07:58So you need to get a really good seal to make sure that there's no air escaping and that
08:02everything is channeled through the speaking valve because that's what gives the best
08:05quality voice.
08:06And in terms of the pandemic as well, this dramatically reduces hospital visits, right?
08:12So how impactful has it been during the pandemic for these vulnerable people?
08:16Absolutely.
08:16We were obviously at the height of the pandemic wanting to prevent people from coming into
08:21hospital sites as much as possible.
08:23So the fact that we've got a successful treatment pathway that allows patients to have a longer
08:29time between hospital visits is much better in terms of reducing their risk of infection
08:35and protecting patients and staff.
08:38In males across the UK, head and neck cancer is the fourth most common.
08:43And most head and neck cancers actually occur in the larynx.
08:48Kent Cancer Trust funds projects that seek to improve the treatment of cancer patients
08:52in Kent, and they helped to put the team of experts together for this project.
08:59Clearly, I hadn't appreciated that there was a real problem with patients who'd had
09:07their larynx removed.
09:08What we were asking them to do was to find out what caused the problem, how that problem
09:14could be fixed.
09:14We've supported a whole range of cancer-related projects where we've undoubtedly increased
09:21people's knowledge, but we haven't actually come up with something which is actually tangible
09:28and which makes a difference to people.
09:30To find that we've actually achieved that, I think is really tremendous.
09:34What we've achieved, we've made a difference.
09:38Laryngectomy procedures extend beyond just Kent, of course, and the project has helped
09:43patients across the UK and the world.
09:46We have distributed the guidelines for the treatment of the valves quite widely over
09:51the UK to different trusts, but also worldwide.
09:54So we've sent the guidelines to Australia and the US.
09:57There are currently around 60,000 laryngectomies that have one of these devices fitted.
10:02It's the gold standard for speech restoration.
10:04A day is a long time for patients and hospital staff.
10:07Have you looked into the costs for the NHS, for example?
10:10Well, there are a few things to consider when you're calculating the costs.
10:12Of course, there is the ongoing treatment, the replacement of the valves, the clinician's
10:18time.
10:19It certainly saves many millions to the NHS.
10:23As a result of this team's success, they can apply a similar strategy to patients who
10:28have had a tracheostomy.
10:29This is done when people have trouble breathing, like you see in hospital programmes.
10:34They're also helping those who use a feeding tube to pass nutrients into their stomach,
10:38which can make you really vulnerable to infection.
10:41They're also working on something pretty high-tech too.
10:44This involves collaborating with engineers and polymer scientists to build electronic
10:51devices that can be embedded within prosthetics and can detect the microorganisms attaching
10:59and growing on their surface.
11:01So a patient who had one of these fitted with one of our detection chips would be able
11:07to, using a handheld device, monitor whether their device is becoming infected or not from
11:14outside the body.
11:16The future is exciting, but right now a lot of people are safer and will have found their
11:22voice again.