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Botox Boost For Voices Silenced By Cancer

Times of India
27 August 2010
Mumbai, India

With a doctorate in chemistry, Geeta Mishra knew of botulinum toxin, the naturally occurring substance now widely used as an anti–wrinkle cosmetic tool. What the 40–yearold lecturer from Madhya Pradesh never expected was that botulinum toxin would be instrumental in reducing the destruction wreaked by cancer on her voice box.

Incidentally, the city is among the few centres in the world where the chemical is used to help cancer patients find their voice. Both at Tata Memorial Hospital in Parel and Kokilaben Dhirubhai Ambani Hospital in Andheri, this delicate procedure is performed on the unfortunate few in whom the artificial voice box fails to work. Take the case of Mishra itself. The Shahdol lecturer discovered she had voice box or larynx cancer only when her voice started thinning. "Students would complain that they couldn’t hear me in the classroom,’’ she said, a finger firmly on the ‘button’ that makes her voice box prosthesis work.

On October 2009, her larynx was removed. "A few months later, an artificial voice box was fitted but I was devastated to learn I couldn’t speak a word,’’ recalled the mother of two. It was the worst cut, she added, when her 17–year–old son asked her if she would never be able to teach him chemistry. All that changed when they met Dr Mandar Deshpande of Kokilaben Hospital in Mumbai.

Botox Boost For Voices Silenced By Cancer
"Mishra is among the unlucky few patients in whom the pharyngoesophageal segment (PE) of the laryngeal muscles go into an hyperactive phase,’’ said Dr Deshpande. There are no clear–cut answers on why this happens, but in three years Dr Deshpande and his team helped over a score of patients with botulinum toxin shots. He started using botulinum shots when at Tata Memorial Hospital in Parel. "In the US, where the technique was pioneered, over 300–odd cases have been done,’’ he added.

The idea of a botulinum shot is to paralyse the over–active PE segment just so much so that it allows sound to be produced (lung air induces vibration of the PE segment to produce sound). "We first have to conduct tests to determine the reason that the prosthesis isn’t working is indeed an overactive PE segment. We then have to identify the exact length of the segment that is hypertonic and inject the botulunim toxin at a gap of 1 cm apart,’’ explained Dr Deshpande. He has helped Mishra and Thane resident Raghunath Jadhav ‘find’ their voice.

"Five shots of botox restored my voice within 12 hours,’’ recalled Mishra.
Dr Pankaj Chaturvedi, associate professor at Tata Memorial Hospital, says botulinum toxin shots are the standard operating procedure in patients who cannot get rehabilitated even after surgery. "We approximately operate on 2,000 cancer patients a year. About 140 patients suffer from laryngeal cancer and need removal of their larynx. The artificial voice box works in about 90%, the remaining 10% need botulinum toxin shots,’’ he said, adding his hospital routinely does the procedure for patients.

"Now that I can speak, I am looking for a permanent posting as a lecturer,’’ said Mishra.

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