Voice and Resonance Disorders 75vocal cords. The doctor pushed a tongue blade down on Tim’s tongue to maximize the viewing
surfaces. He saw two small growths on the vocal cords and deci ded to remove them surgically.
On the morning of surgery, Tim was given a general anesthetic. A scope with a device to cut
the growths from his vocal cords was lowered down his throat. Once the nodules were removed,
they were sent to the hospital’s lab for biopsy. Within hours, the results were available; the nodules
were benign. However, many months later, Tim was diagnosed with cancer of the larynx. There
were several pos si ble reasons why it had not been discovered during the earlier surgery. Either the
cancer had not yet developed, the biopsies were wrong (false negatives), or the cancer was below
the vocal cords and out of sight during the laryngoscopy and surgery. Sadly, had the cancer been
discovered earlier, perhaps a complete laryngectomy and radical neck dissection would have not
been required. By the time the cancer was discovered, it had spread beyond the larynx to adjacent
tissue. Consequently, Tim’s entire larynx was removed, along with some tissue in his neck and
shoulder. He also endured radiation therapy and chemotherapy.
Between the time of nodule surgery and the diagnosis of cancer, Tim received voice therapy.
The therapy was provided to prevent the return of the nodules in the mistaken belief that they
were a result of vocal strain and abuse. Initially, Tim’s voice improved but the hoarseness was not
eliminated. The voice therapy was ultimately unsuccessful, Tim’s voice degenerated, he became
aphonic, and the laryngectomy was performed.
After the laryngectomy, Tim chose to use an electrolarynx rather than other alaryngeal meth-
ods of communicating. He purchased a high- quality vibrator from a telephone com pany and
quickly learned how to use it. At first, its use was painful because his neck was sore due to the sur-
gery and radiation treatments. Gradually, he was able to tolerate more pressure on his upper neck.
Tim learned that by firmly placing the vibrating diaphragm of the electrolarynx on his neck and
directing the energy upward through his oral and nasal cavities, he could produce intelligible, clear
speech by mouthing the sounds. The electrolarynx creates a buzzing, “metallic” type of speech,
but it is usually intelligible. In addition, the type of electrolarynx used by Tim had a variable fre-
quency setting so that he could adjust the vibration of the diaphragm to maximize the efficiency
and quality of his artificial voice. The off-on button was used to produce sound only during the
actual utterance, reducing the obtrusiveness of his speech.
Even after the laryngectomy and the news that the cancer had returned and spread, Tim
remained active and upbeat. He could no longer pi lot his private single- engine Piper Cub airplane
due to his communication disorder and because one hand had to hold the electrolarynx in place
while talking. However, his friends with private pi lot licenses frequently took him on plea sure
f lights where he could again take the controls, execute steep dives, make hard banks, and soar over
the mountains and lakes of the country he had served so well.