Artificial Larynx Helps Cancer Patient Speak and Smell

A new study describes how an artificial larynx implanted after total laryngectomy allows a 56-year-old man to speak with an intelligible whisper and breathe normally.

Developed by researchers at CHU de Strasbourg, the French National Institute of Health and Medical Research (INSERM), and Institut Claudius Regaud, the ENTegral artificial larynx consists of a permanent titanium tracheal prosthesis with a porous distal end to improve soft-tissue integration, and a removable titanium cap that replicates the function of the epiglottis, allowing continuous passage of air and fluids while protecting the patient’s airway from aspiration. When the patient coughs, the upper flap can open transiently to allow the expulsion of bronchopulmonary secretions.

The patient in question underwent total laryngectomy and bilateral cervical lymphadenectomy. In phase 1 of the procedure, the permanent tracheal prosthesis was implanted with a temporary closed cap. Four months later, in phase 2, it was removed and replaced with a removable open-ventilation cap. During a 16-month follow-up period, stenosis did not develop at the trachea–prosthesis anastomosis, and the patient could breathe and expectorate through the upper airways and maintain adequate arterial blood hemoglobin saturation while breathing ambient air.

The patient was able to speak and swallow saliva during the day and at night, although occasional aspiration of food occurred. The patient’s olfaction, which had also been compromised, was completely restored. In addition, the artificial larynx did not interfere with any planned radiotherapy, and the patient wasalso able to close the fenestrated tracheostomy cannula for six or more hours per day in order to breathe through the upper airways. The study describing the artificial larynx was published in the January 5, 2017, issue of the New England Journal of Medicine (NEJM).

“No episodes of pneumonia, infection, discharge, difficulty breathing or blockages were observed after 16 months of daily use. This implant is constantly evolving and the next patients will benefit from substantial improvements to improve the passage of food down the throat,” said study co-author Nihal Engin Vrana, PhD, of INSERM. “Patients who have had a total laryngectomy are the ideal candidates for this device. However, following surgery, they still must have the base of their tongue, to help preserve swallowing function.”

The larynx, also called the voice box, houses the vocal cords, which are essential for phonation. It also manipulates the pitch and volume of sounds produced. Located in the neck of tetrapods, the larynx is also involved in breathing and protecting the trachea against food aspiration. The laryngeal skeleton consists of six cartilages: three single (epiglottic, thyroid and cricoid) and three paired (arytenoid, corniculate, and cuneiform).