Cordless Speech

Every year 2,000 Americans have their larynxes removed because of cancer and have to learn to talk all over again. A few do it with the aid of mechanical devices; more than half do it by learning painstakingly to swallow air and belch it back to vibrate their gullet muscles rather than their missing vocal cords. But 40% of patients give up in despair, never learn to utter much more than grunts.

Last week Surgeon John J. Conley of Columbia-Presbyterian Medical Center and St. Vincent's Hospital in Manhattan told the James Ewing Society (of cancer researchers) of an added operation that makes it far easier for laryngectomy patients to talk again. The basic surgery is unchanged: leading the windpipe out through a hole in the neck-just below the Adam's apple. But Dr. Conley's team goes a step farther, makes an artificial air tunnel from about this same point in the neck to connect with the esophagus (gullet). Handiest material to use in making the air tunnel, the surgeons have found, is a three-inch piece of vein taken from the patient's leg. A removable plastic or metal insert diverts air from windpipe to tunnel.

With the extra air passage built in, Dr. Conley explained, when the patient breathes out he automatically sends enough air through the special tube into his gullet to make it vibrate. The resulting "esophageal speech" is of about the same quality as that made possible by the swallowed-air method. Main difference is that as soon as the surgical wounds heal, the patient can begin to talk without special training. Surgeon Conley's hope: the technique should make it possible for all laryngectomy patients to talk more easily, and restore speech to most of the mute 40% who have found previous methods too difficult.

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