Woman Talks Again After Receiving Larynx Transplant
For 11 years, Brenda Charett Jensen couldn’t speak. She communicated through an electronic device that sounded like a robot. When the batteries ran out, her conversation was over.
Jensen lost her ability to speak after a breathing tube permanently damaged her airway during surgery in 1999. She breathed through a tracheotomy tube, which extended from a hole in her neck. Because Jensen could not pass air through her nose and mouth, she lost her senses of taste and smell.
On Thursday, Jensen emerged with her doctors from University of California Davis Medical Center. And she had something to say.
“It’s been a long journey,” she said, while thanking her doctors and the organ donor’s family. “I’m still working hard, but it’s improving every day.”
Her voice sounded hoarse and deep, and crackled a little.
In October, Jensen became only the second person in the United States to receive a larynx transplant. The larynx, also called the voice box, is a tube-shaped organ in the neck that is instrumental in breathing, swallowing, and talking.
“After 12 years of a lot of humiliation from the kids, the adults staring at me because I talked with a mechanical machine. Everywhere I was, people turned around,” said the 52-year-old Modesto, California, resident. “It was frustrating that I had to live with it. When this opportunity came up, I wanted to talk again, and I’m doing it.
“It was very much worth it.”
Jensen received a donor’s larynx, thyroid and a portion of her trachea during an 18-hour operation. UC Davis surgeons connected five nerves, three arteries and two veins in the October operation. The hospital funded most of the surgery.
Two weeks after the transplant, Jensen started to speak. Her first words were “Good morning” and “I want to go home.”
Her daughter, hearing her mom speak for the first time in more than a decade, cried “like a baby,” Jensen said.
“Well, to me, I sound raspy and gurgly in the mornings,” she said. “I hear myself in answering machines, it sounds pretty good. I’m impressed.”
Jensen’s voice is her own, not the donor’s.
This is because a voice is not shaped solely by the larynx. The signature sound of an individual’s voice is formed by the vocal tract and the various structures in the mouth.
“What happens is vocal folds are vibrators,” said Dr. Marshall Strome, a surgeon who is not affiliated with Jensen’s care. The resonance of the voice is affected by the shape of a person’s oral cavity, mass of the tongue and sinuses. “That’s different for everyone.”
The transplant has risks.
The larynx is considered nonessential, because a person can live without the organ, as Jensen did for more than a decade.
A transplant poses risks to the patient, because it means that he or she will have to take medication for life to suppress the immune system. A weakened immune system means the person would be less able to fight infections and cancers.
But Jensen was already taking immune-suppressing drugs, because she received a kidney and pancreas transplant four years ago, doctors said.
After the surgery, Jensen underwent two months of rehabilitation to restore her voice.
“She’s developing sensation and developing movement in the vocal cords,” said Gregory Farwell, associate professor of otolaryngology at UC Davis and lead surgeon for the transplant. “Nerves take a long time to regenerate. Her voice will continue to heal.”
Doctors said that Jensen can now smell and taste. She receives therapy to improve her swallowing, so she can eat and drink on her own. Her tracheotomy tube could be removed in a few months, Farwell said.
The only other person to receive this rare transplant is Tim Heidler at the Cleveland Clinic in 1998.
“It’s changed my life dramatically, being able to talk and communicate,” said Heidler, a Pickerington, Ohio, resident, who speaks in a low, husky voice.
Without the ability to communicate, “the stress is unbelievable,” he said. “You either write it down or sign language or communicate with a robotic device. It’s not easy.”
Patients who lose their ability to talk usually stay home, he said. Thirteen years after his surgery, Heidler, 53, said he never regretted having the operation, despite having to take daily anti-rejection drugs.
He spoke with several pauses as he breathed through his tracheotomy tube.
“Try walking around for an hour and tape your mouth shut,” he said. “You’d be frustrated in 15 minutes. You can’t imagine it till it happens to you. You take your voice for granted, your life for granted.”
Heidler injured his neck in 1978 as he was riding his motorcycle to a firefighting training session. On a Pennsylvania trail, he hit a steel cable strung between two trees. The accident destroyed his larynx.
He now speaks on behalf of organ donation efforts.
“The ability to produce a voice is part of our humanity,” said Heidler’s current doctor, Dr. Douglas Hicks. “It’s one of our determinations of self-confidence.”
Even after Heidler’s successful surgery, larynx transplants have been unusual in the United States.
Trauma to the larynx is rare, because it’s well-protected in the neck, said Strome, who performed the first larynx transplant and is chairman of the board of the New York Head and Neck Institute.
Most damages to the larynx come from cancer. But transplants for cancer patients are risky.
Transplant patients are more susceptible to cancers, so “most people feel the risks are too great at the moment” for nonessential organs like the larynx, Strome said.
A vast majority of larynxes can be reconstructed by putting the cartilage back together, putting stents or sutures, he said. Another option is to work with a speech pathologist to learn esophageal speech, a method of vocalizing using the esophagus.
Because of these options, larynx transplants have been rare, said Hicks, the director of the Cleveland Clinic’s Voice Center.
“From a financial, technical expertise, the insurance issues, the ethical issues — these still exist,” he said.
The transplanted larynx that Jensen received came from a car accident victim. The donor’s family gave permission for the transplant and wanted to remain anonymous. She thanked them numerous times.
Jensen, who has endured 80 surgeries in her life, said she’s upbeat about her prognosis.
“I never know what’s coming tomorrow, but I know it’s better than where I’ve been,” she said.