This is the Amazing Power of Voice

Imagine that you awaken tomorrow, and no longer have a voice. You awaken, stretch, and yawn, but there is not any sound. There’s only the motion of your mouth. You clear your eyes, sit at the edge of the bed, and clear your throat. You even attempt to cough. But nothing comes out, save for the sound of air escaping as if the air in a balloon suddenly released from its valve. I’m not talking about run-of-the-mill laryngitis, with a raspy, gravelly hoarse voice, but true voice loss – aphonia, in the parlance of the ear, nose, and throat surgeon.

Without a Voice

In the last two months, I have operated on three aphonic people – without a voice. One was a woman with metastatic lung cancer that had invaded the nerve to her left vocal cord, leaving her with only breathiness when she tried to speak. Additionally, because excess air escaped during each attempt to speak, each attempt to talk led to a phenomenon called air-wasting, leaving the speaker exhausted and out of breath. This is the medical equivalent of one-hand clapping.

The second person was a woman with a neuromuscular disorder that had caused her vocal cords to atrophy, or shrink, such that they were bowed away from each other. Vocal cords need to be straight and to touch in the middle of the voice box when we speak. Bowing or curvature of each one from such atrophy leads to similar breathiness and air-wasting. So instead of one-hand clapping, think of a mime clapping. The gesture is there, but nothing comes out.

The third person was a man whose voice box I removed due to cancer. In his case, the vocal cords were gone, with the trachea now exiting the base of the neck, completely bypassing the mouth. Only air comes out, no voice.

I discuss these three people because all expressed to me their frustrations with their lack of voice production. They each described themselves as feeling powerless, unheard, shunned, isolated, overlooked, and even insignificant. And as much as I have seen these scenarios numerous times in my practice, I never cease to be amazed by the recurrent expressions of these sentiments by people who have lost their voices. In fact, I think I am most impressed by the impact of voice loss when such patients return for postoperative visits after I have performed a voice restoration procedure.

Such was the case for the three people above:

• The first patient, the woman with a vocal cord paralysis, underwent repositioning of her vocal cord, a procedure performed while she was awake so that I could fine tune her voice.
• The second person underwent injections of a filler material into both vocal cords to compensate for the loss of bulk from atrophy. I also performed this surgery while she was awake.
• The third person, whose larynx was removed, underwent the placement of a valve between the trachea and esophagus, allowing him to breathe air in via the trachea and then exhale that air through his esophagus and into his mouth, giving him speech.

The Importance of Our Voice

What is amazing in all three cases, as well as many similar cases in which I have been involved, is not the fact that we have such procedures in our armamentarium of voice treatments, but the impact that restoration of voice has on these people. Invariably, the first thing I hear is a statement that distills down to, “Thank you for giving me back my voice.” Usually, there are additional statements, such as, “I can finally be heard again,” “I feel I have some power again,” “I no longer feel isolated,” and “I have my life back because I can communicate again.”

Keep in mind that, with the first two people mentioned above, their diseases are terminal, and they likely have six to twelve months of life expectancy. The third person, who had his larynx removed, is cancer-free and is a survivor at this point.

These cases drive home to me the importance of our voices. I’m not going to go on a long diatribe about not taking our voices for granted or being grateful that we have a voice – that would require my being your guide on some type of guilt trip. Instead, my goal is to first illustrate the importance of each individual voice. We each find power in our ability to express ourselves.

Now clearly we think of such expression as coming initially in the form of the voice we generate from our throats, usually by virtue of having a normal voice box, but sometimes through other techniques to generate speech, be it an alteration of the normal flow of speech through the throat, as evidenced above, or through completely different voice generators, such as computerized pads that generate speech, as demonstrated by individuals such as Steven Hawking.

Then, of course, there are the means of finding our voice in the many modalities that are not the simple speech patterns that commonly come to mind when we initially think of “our voice.” Many of us find our voices in art – poetry, painting, illustration, music (singing or, in my case, guitar-playing), or writing (such as this blog). Perhaps our voices lie in political speech, religious conviction, or community service. Our voices may be expressed in athleticism – that is, expressing our individuality in physical and mental talents applied to a competitive challenge. Our voice may be expressed in intellectual ways – solving a complicated mathematical or scientific problem, or creating a computer program to expedite a specific process.

These are ways we find and express our individual voices. At some level, conscious or unconscious, we understand the devastation we would feel if that voice were suddenly lost or severely compromised. We realize the loss of individual power we would feel if that voice were somehow silenced.

The Power of the Collective Voice

I now make the jump to next level of voice, the collective voice. This is the voice we hear when a group is able to express itself. We are fortunate to live in a country in which we often see those voices rise. In politics, those voices are heard at rallies which may be a gathering of Democrats, Republicans, Independents, Libertarians, etc. We hear special interest groups speak out – Pro-Choice, Pro-Life, Pro-Union, Anti-Union, Pro-Pipeline, or Anti-Pipeline. Many of these discussions have played out in a political arena. But the collective voices go well beyond that. Groups seeking equality for racial minorities, for LGBTQ people, or for women both in terms of health needs and wage equality.

These are all important voices. Often, they are heard as voices in the vocal/speech sense, but they often express themselves via articles, artistic expressions, dance, song, illustrations, animations, paintings, graffiti, or poetry – these are all manifestations of collective voices. And these voices have led to awareness and, in many cases, to change.

But the collective voices go well beyond that. Groups seeking equality for racial minorities, for LGBTQ people, or for women both in terms of health needs and wage equality. These are all important voices. Often, they are heard as voices in the vocal/speech sense, but they often express themselves via articles, artistic expressions, dance, song, illustrations, animations, paintings, graffiti, or poetry – these are all manifestations of collective voices. And these voices have led to awareness and, in many cases, to change.

Sometimes the group itself can raise such awareness, while in other situations, a champion arises out of the group – Martin Luther King, Jr., of course, comes to mind, but also recall such people as Susan B. Anthony (women’s suffrage movement) and Crystal Lee Sutton (the union activist upon whom the movie Norma Rae was based). There will always be opponents to such voices, and our freedoms allow all collective voices to be heard – some popular, some not, some who will win, some who will lose, and in some cases, some whom history may prove to be either right or wrong.

When Voices Aren’t Heard

Finally, consider the voices that are not heard – the voices that may even be willfully silenced. My patient examples above (prior to their surgeries) show the individual frustrations of inability to speak. Looking at the second group, the collective voices, we know that there are many segments of our population that continue to feel silenced or, at least, to not be fully heard. We know that minority populations continue to yearn for educational opportunities that many of us strive to provide, but that any of us also realize are still wanting.

We know there are groups that feel silenced when they ask why there are wage inequalities, lack of promotion opportunities, and glaring discrepancies in crime statistics for various groups. I remain optimistic that at least the fact that we know of these voices means that we have the opportunity to address these problems. Although it may seem like old news, I recently watched another video of the Syrian children dying from the chemical weapon attack a few months ago, and I realized that there are populations of people who, for all practical purposes, have no voice whatsoever.

They cannot speak out, they cannot ask for help, and they are at the whim of the people who oppress them. When I realize that, I realize how great it is that we live in a country in which we can speak out, we can have voices.

More importantly, I believe that many of us can be the voices for those who cannot speak or who are repressed when they try to speak.

I am not a minority, but I write these posts to help bring attention to the need for racial equality. I am not a woman, but I support gender equality through my words and actions. I am not gay, but I fully support the LGBTQ community.

Perhaps, beyond our individual voices and our collective voices, there is another important voice – the voice we express for those who are not able to speak for themselves, for those who are truly powerless. Whether it is to advocate for the special needs student who is isolated, the minority coworker who is harassed, the religious refugee who is accosted, or the Syrian child who is poisoned, it is imperative for us to be their voice and to express our belief in equality and human decency.

Anything less would be unspeakable.

 

Arthur M. Lauretano, MD, MS, FACS

5/10/17