Speaking Again

Better to sound like Satchmo

In 1970 Bessie Parello, then 47, became one of the 10,000 Americans a year who develop cancer of the voice box, or larynx. To remove the cancerous tissue, surgeons perform an operation called a laryngectomy on many of these patients. Because the surgery disrupts the windpipe, the surgeon must create a small hole in the throat for breathing. But talking is another matter. Some people can learn to gulp air through the mouth, force it down the esophagus, or gullet, instead of the windpipe, and literally burp it back up into a cavity called the pharynx, where a rough facsimile of the natural voice is produced. But like all too many throat cancer patients, Parello was never able to master such esophageal speech. "I just couldn't do it," she recalls. "My children learned to understand me by lip reading. My husband couldn't understand me at all."

Today not only can Parello talk again, but her speech is astonishingly understandable. What has given Parello and hundreds of other victims of throat cancer in the U.S. and Europe new voices is an ingenious operation developed by an Italian surgeon.

For decades doctors had tried to divert air from the windpipe back up into the blocked-off pharynx. But such efforts inevitably failed; food and water would get into the windpipe, causing choking. In 1969 Dr. Mario Staffieri of Piacenza, near Milan, Italy, tried a new approach, inspired by a famous case in medical annals. Forty years earlier, a Chicago iceman, suicidally depressed by the loss of his voice after a laryngectomy, had plunged an ice pick into his throat. Instead of dying, he regained the ability to speak; he had accidentally pierced the esophagus wall in a way that gave him a voice again.

To duplicate that miracle, Staffieri made a small slit in the esophagus of a laryngectomy patient. Then he flapped part of the esophageal wall over the top of the trachea, forming a valve linking windpipe and pharynx. To speak, the patient simply placed a finger over the external breathing hole in the neck. Exhaled from the lungs, air was forced through the internal esophageal slit, allowing the pharynx to vibrate and create sounds. But the valve could open only when air from the lungs forced it open. When food or liquid came down the esophagus, the valve remained closed.

Staffieri has performed the operation on 137 patients, with a success rate of 90%. At first, his technique did not get much attention in the U.S., partly because American specialists did not know much about it. But in 1976, at the urging of U.S. Air Force Surgeon Frederick McConnel, who had seen Staffieri's work, Northwestern University's Dr. George Sisson tried the operation on a throat cancer patient deeply depressed at the prospect of losing her voice. The results were remarkable, as were those of another early patient, Bessie Parello, who could speak 20 minutes at a time two weeks after her operation. Since then at least 75 people in Chicago, Atlanta and Galveston have undergone such surgery.

Since breathing is easy, the new voice can be sustained about as long as normal speech. It has a raspy quality faintly reminiscent of Louis Armstrong, but is notably superior to other voice-restoration techniques. Besides, most people probably would prefer a voice like Satchmo's to embarrassed silence.

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