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Saturday, 5 August, 2000, 23:00 GMT 00:00 UK
Poison helps patients speak clearly
Surgery
Major throat surgery can leave patients without normal speech
One of the world's most powerful natural poisons is being used to help patients regain speech after major throat surgery.

Many patients who have their voice box or larynx removed find it difficult to return to normal levels of speech.

Air is normally directed through the voice box to make a sound, but when this is removed, the patient has to precisely control throat muscles instead.

Research carried out by doctors at the University of Texas found that injecting patients with a powerful neurotoxin can help.

Trying to control the flow of air without the benefit of the neurotoxin leads to muscle spasm which disrupts the sound.

The botulinum toxin or botox paralyses nerves and muscles.

Multi-use of toxin

It has been used by doctors to treat muscular disorders such as eye spasms and cosmetic surgeons have used it to relax facial muscles to improve wrinkles and furrows.

Doctors at the MD Anderson Centre in the University of Texas gave the toxin to 19 male and four female patients.

They made a hole into the throat from the neck following partial or total larynx removal operations.

None of the patients, who were aged between 37 and 83 years, had managed to speak fluently following their operations.

To doctors, fluent speech is defined as producing 10 to 15 syllables per breath or sustaining vowel production for a minimum of 10 seconds.

But 20 of the patients managed "normal" speech production after they were injected with botulinum toxin.


Patients do well with this therapy

Dr Jan Lewin, University of Texas

Research leader Dr Jan Lewin said 15 of the 23 patients achieved conversational speech following the first injection.

The remaining eight patients were offered a second injection six to eight weeks later.

Speech was achieved in four of the six who received a second injection. The remaining two patients had a third injection and one achieved conversational speech.

The patients showed no adverse reactions. They have been followed for almost three years and only one patient has required a follow-up injection at five months to maintain conversational speech levels.

"Botox is an excellent, simple and effective tool to allow people who don't achieve speech success with tracheoesophageal puncture to regain speech function," said Dr Lewin.

"Patients do well with this therapy where there is a multi-disciplinary approach to their treatment."

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