00:00Think about the way you eat, breathe and speak. It's not something many people truly think
00:23about but for many they do all of this with the help of a voice prosthesis. Your larynx
00:31is where your vocal cords are, so when someone has a total laryngectomy, meaning their larynx
00:35is removed, they can no longer speak. The air that comes from their lungs no longer
00:40comes out through their mouth, it comes out through a hole in their throat called a stoma.
00:46So when patients get fitted with a prosthesis it involves the small device being put in
00:50the trachea. This diverts air from the lungs through a valve and into the esophagus, otherwise
00:56known as your food pipe. It then puts the air back into your mouth. Through vibrations
01:02created and training with a speech and language therapist, patients can learn to speak again.
01:08But of course you have to eat and with that comes bacteria and microorganisms. The bacteria
01:14in your mouth can stick to something called biofilm at the top of the device and this
01:20build up can stop it from working. There are serious potential consequences if this
01:24voice prosthesis becomes infected, so preventing this biofilm from forming was the key to helping
01:30patients. Almost a decade ago here at the University of Kent, Dr Campbell Gourlay helped
01:37to develop a way to keep the valve clean. Alongside Kent Cancer Trust, the Biosciences
01:43team joined forces with other scientists and clinicians and they found that the voice prosthesis
01:48would frequently fail because of a yeast called candida albicans. So they developed
01:54something called an antifungal treatment strategy to try and extend the life of the voice prosthesis.
01:59This would mean that patients would get their valve changed less, but also hospital visits
02:03would be dramatically reduced. So to go into a little bit more detail is Dr Campbell Gourlay.
02:10I went to visit him at his lab at the University of Kent to see what the voice prosthesis looks
02:15like, but also see how something so simple can drastically help the lives of hospital
02:21staff and patients. So I'm a cell biologist and a microbiologist, which means that I'm
02:28interested in the study of microorganisms. We were contacted by the local hospital trust
02:33by the speech and language therapist there, who was interested in trying to improve the
02:38quality of life of her patients who were fitted with one of these devices. This little thing
02:43here, which is called a voice prosthesis or speaking valve, is applied to patients
02:48when they have had their larynx removed. And this is typically patients who've had advanced
02:54laryngeal cancer. So alongside the antifungal gel is almost like a toothbrush that you would
02:59use for your teeth. Explain a little bit more about how patients would use that. Yeah, of
03:03course, you're quite right. It is exactly like brushing your teeth. And they've simply
03:07brushed their prosthetic twice a day by inserting the brush that's provided by the manufacturer.
03:13And it quite nicely fits in and cleans the valve. So the application of the antifungal
03:19will help to prevent the biofilm from forming on the prosthetic. And just as cleaning your
03:24teeth would stop plaque buildup, which is a biofilm, you stop the biofilm from building
03:30up on the prosthetic. For much longer, just to give you an idea of the timescale, patients
03:36would sometimes have to come in every two weeks to have their valve changed. And so
03:41our patients that are on our pathway would typically be anywhere between six months to
03:48two years before they would need a replacement instead of two weeks. Okay, so the numbers
03:52are impressive. But what about the everyday reality of a patient who's going through the
03:56treatment pathway? I went to Kent and Canterbury Hospital to meet Rich, who was diagnosed with
04:01cancer in 2008. He had to have his larynx removed along with radiotherapy as part of
04:07his treatment, and then years later, became a part of the research. He met me with his
04:13wife Jenny to chat about what the prosthesis is really like day to day, and how their lives
04:17have changed. Getting that news must have been, well, terrifying, I guess.
04:23One of my fingers. Yeah. Can't deny that. No. He was losing his voice for quite a while.
04:33Couldn't hear him, it was a whisper. He decided to go to the doctors and then everybody was
04:38very quick to put Cancer Pathways into operation to find out what was going on. And he had
04:45a total laryngectomy with reconstructive surgery of his throat. So he doesn't breathe at all
04:52through his nose, it's all through that valve in his throat. Later on, they put the speech
04:57valve in, and then obviously from there, he learnt how to talk with a valve and how to
05:05cough properly by taking in some breaths or something, wasn't it?
05:09So tell me a little bit about your journey from then to now.
05:11The valve that goes in my throat, had to have that changed quite often, originally.
05:20When he started, it was a maximum three months he would go, but generally it was around six
05:26weeks and him changing that valve, and that trauma as well, keep changing that valve in
05:31his throat.
05:48Has it, you know, helped and changed your life a little bit, knowing that you don't
05:51have to worry as frequently?
05:56At the moment, anyway, most of the times it would.
06:00Was it strange to kind of learn how to talk again, in a way?
06:04Yes, quite, yeah, the greatest time, originally.
06:08Language time, so very, very important.
06:13Absolutely, you wouldn't be able to speak to people properly, would you? You wouldn't
06:18be able to use your phone. Yeah, you'd just be joining in, but not really there.
06:25Layla Williams is a speech and language therapist.
06:28She works with many patients who have had the device fitted and can be with them on
06:32their journey for decades, helping them to speak in a new way and adapt to this monumental
06:38change in their lives.
06:39She is one of the few who knows the impact that having a voice prosthesis fitted can
06:43have on patients and hospitals.
06:46This device, this treatment helps people to speak and eat and breathe.
06:51So how impactful is it and how important is it?
06:54Because, you know, people lose their voice in a way and they have to then relearn how
06:59to speak.
06:59Absolutely.
07:00So immediately after surgery, patients don't have a voice at all.
07:05And until a voice prosthesis or a speaking valve is fitted, they may need to use alternative
07:10means of communication.
07:11So that could be mouthing, writing things down.
07:15And then once they are given the opportunity to have a voice again, it can actually be
07:19quite emotional.
07:20And we find sometimes that patients are quite tearful and they can tell their loved ones
07:26things for the first time they haven't been able to say for a number of weeks sometimes.
07:31What kind of specific things do you do with these patients to help them recover and move
07:36on with their lives?
07:37So getting the technique right for producing voice is really important.
07:43To be able to divert the air that's coming normally in and out of the stoma when a patient
07:48is breathing, we need to teach them how to divert that air through the speaking valve.
07:52So that means covering over the stoma, the breathing hole in the front of the neck.
07:58So you need to get a really good seal to make sure that there's no air escaping and that
08:02everything is channeled through the speaking valve because that's what gives the best
08:05quality voice.
08:06And in terms of the pandemic as well, this dramatically reduces hospital visits, right?
08:12So how impactful has it been during the pandemic for these vulnerable people?
08:16Absolutely.
08:16We were obviously at the height of the pandemic wanting to prevent people from coming into
08:21hospital sites as much as possible.
08:23So the fact that we've got a successful treatment pathway that allows patients to have a longer
08:29time between hospital visits is much better in terms of reducing their risk of infection
08:35and protecting patients and staff.
08:38In males across the UK, head and neck cancer is the fourth most common.
08:43And most head and neck cancers actually occur in the larynx.
08:48Kent Cancer Trust funds projects that seek to improve the treatment of cancer patients
08:52in Kent, and they helped to put the team of experts together for this project.
08:59Clearly, I hadn't appreciated that there was a real problem with patients who'd had
09:07their larynx removed.
09:08What we were asking them to do was to find out what caused the problem, how that problem
09:14could be fixed.
09:14We've supported a whole range of cancer-related projects where we've undoubtedly increased
09:21people's knowledge, but we haven't actually come up with something which is actually tangible
09:28and which makes a difference to people.
09:30To find that we've actually achieved that, I think is really tremendous.
09:34What we've achieved, we've made a difference.
09:38Laryngectomy procedures extend beyond just Kent, of course, and the project has helped
09:43patients across the UK and the world.
09:46We have distributed the guidelines for the treatment of the valves quite widely over
09:51the UK to different trusts, but also worldwide.
09:54So we've sent the guidelines to Australia and the US.
09:57There are currently around 60,000 laryngectomies that have one of these devices fitted.
10:02It's the gold standard for speech restoration.
10:04A day is a long time for patients and hospital staff.
10:07Have you looked into the costs for the NHS, for example?
10:10Well, there are a few things to consider when you're calculating the costs.
10:12Of course, there is the ongoing treatment, the replacement of the valves, the clinician's
10:18time.
10:19It certainly saves many millions to the NHS.
10:23As a result of this team's success, they can apply a similar strategy to patients who
10:28have had a tracheostomy.
10:29This is done when people have trouble breathing, like you see in hospital programmes.
10:34They're also helping those who use a feeding tube to pass nutrients into their stomach,
10:38which can make you really vulnerable to infection.
10:41They're also working on something pretty high-tech too.
10:44This involves collaborating with engineers and polymer scientists to build electronic
10:51devices that can be embedded within prosthetics and can detect the microorganisms attaching
10:59and growing on their surface.
11:01So a patient who had one of these fitted with one of our detection chips would be able
11:07to, using a handheld device, monitor whether their device is becoming infected or not from
11:14outside the body.
11:16The future is exciting, but right now a lot of people are safer and will have found their
11:22voice again.
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