A Chance To Speak Again

Amy Hancock may be getting her voice back soon.

Hancock, 26, lost her larynx to cancer five years ago. Rare surgery Friday at Barnes-Jewish Hospital in St. Louis aimed to restore her voice.

The surgery lasted 10 hours and went well, Washington University School of Medicine spokeswoman Joni Westerhouse said Friday night. It will take three to five weeks to know whether the procedure will restore Hancock's voice, she said.

The St. Louis Post-Dispatch said Dr. Randal C. Paniello, a head and neck surgeon at the Washington University School of Medicine, was to remove tissue from Hancock's left arm during the surgery and fashion it into a tube that may enable Hancock to talk. The surgery has never been done in the United States, but has helped at least 10 people in Germany talk after losing their larynxes.

Hancock recalls the moment she lost her voice, "but not in a bad way," she said.

Many good things have happened to her since she lost her larynx, Hancock said, including getting the five-pound toy poodle, Macie, she dotes on. The poodle is for more than companionship. The diminutive dog is also an alarm system. Hancock lives alone and can't scream if something bad were to happen, she said.

Previous surgeries, including botox injections, have failed to restore Hancock's speech. She uses an electrolarynx, a device that creates vibrations, allowing users to speak, though the sound is robotic.

Hancock, a one-time country music DJ, had to alter her career plans. She now works in the membership office at the Missouri Botanical Garden.

When Paniello approached her with the chance to try the new technique, she jumped at it.

The process, described before Friday's surgery, called for Paniello to remove a patch of skin from Hancock's left arm and take an artery and vein to feed the flap of skin. He was to repair the wound in Hancock's arm with a skin graft from her leg.

The doctor was to fashion the 2-inch-by-2-inch patch of skin into a breathing tube inserted into Hancock's trachea. The German doctors simply extend the windpipe with the tube of skin when the larynx is removed, but Hancock's trachea has been turned to allow her to breathe through a permanent hole in her throat. Consequently, Paniello was to make an incision in the trachea and insert the skin tube to reconnect Hancock's trachea and esophagus.

The doctor also was to use a small piece of cartilage from Hancock's nose to make the flap at the end of the tube stiff. The flap is crucial for the tube to function properly, he said.

Normally the larynx closes to keep food or liquid out of the lungs. The flap should perform the same function. The tube will be positioned so that food or drinks traveling down the esophagus to the stomach push the flap down to cover the tube.

Because Hancock breathes through the hole in her throat, she must block the open trachea to talk. When she covers the hole with either her thumb or a removable valve, air is forced through the tube, causing the flap at the end to open and let the air into Hancock's oral cavity.

Hancock said she looks forward to the chance to express herself without the use of the electrolarynx.

"I think my life will be better with a more normal-sounding voice," Hancock said.

The new voice won't be completely normal, Paniello said. "She won't end up with a high-frequency feminine sound," he said. Physics won't allow it.

In people with intact larynxes, the vocal cords open and close rapidly, producing vibrating jets of air coming from the lungs. The tongue, lips, and mouth shape the vibrating air into the distinctive sound of a person's voice.

Most men's voices have frequencies that range from about 100 hertz to 160 hertz. The lower the frequency, the lower the voice. Women's voices usually range from about 150 hertz to 250 hertz. But the tissues in the neck, including the transplanted tissue from Hancock's arm, vibrate at much lower frequencies - well below 100 hertz - giving patients who talk without larynxes a rumbling, gravely voice, Paniello said.

Hancock said she's realistic about the expectations she has for her new voice.

"I think I'm probably never going to sing a duet with Garth (Brooks), but I probably never would have anyway."