Laryngeal Papillomatosis (RRP) is a devastating disease that affects tens of thousands of patients in the United States, more than half of whom are children. It is not unusual for patients to undergo 50 to 100 procedures. Over the past decade, the MGH researchers have created and established state-of-the-art treatment paradigms including the angiolytic KTP laser, and office-based laser surgery with local anesthesia. Most recently, they introduced and pioneered the use of the anti-angiogenesis drug Avastin for RRP.
The landmark research investigation demonstrating the effectiveness of Avastin with the KTP laser was published as a supplement to the Annals of Otology, Rhinology, and Laryngology in 2009. The MGH researchers are currently completing the first phase of an FDA approved study with promising early results. This research has transformed lives of the MGH patients treated thus far and was featured on Good Morning America and ABC World News. These shows explored former New York City Opera vocalist Mr. Michael Neimann's transformative treatment from the loss of his ability to sing to the resolution of the Papillomatosis and the restoration of his beautiful voice. "For me, the biggest gift I've had is losing it and then getting it back," said Neimann.
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A new treatment for vocal cord cancer developed by Dr. Steven Zeitels and collaborators at the Massachusetts General Hospital has been the subject of several media reports in the US and abroad. The breakthrough was reported by Dr. Timothy Johnson on ABC World News, and was featured in the New York Times and on National Public Radio.
Dr. Zeitels, the Eugene B. Casey Professor of Laryngeal Surgery and the Director of the Massachusetts General Hospital has been innovating vocal cord treatment for precancerous dysplasia and cancer for the past 20 years. This work has culminated in a new laser treatment for cancer, which has produced the best results to date. This treatment employs an angiolytic KTP laser which concentrates the laser energy in the cancer and optimally spares the normal vocal cord tissue to preserve and/or restore the patient's voice. The green light of the KTP laser is highly absorbed by red blood cells which enable it to selectively ablate the increased network of blood vessels (referred to as angiolysis) in cancerous tumors while preserving healthy tissue. The concept of treating cancer by diminishing its blood supply was established by Dr. Judah Folkman years ago.
Dr. Zeitels initiated this new treatment over 7 years ago after using angiolytic lasers for a number of years to treat precancerous dysplasia. The first patient to undergo this treatment was John Ward, PhD, the President of the VHI, who has been teaching and lecturing without difficulty ever since. The initial research investigation demonstrating the effectiveness for this work was published in the Annals of Otology, Rhinology, and Laryngology in 2008. Patients are seeking this cancer care from throughout the US and abroad and the MGH team has now treated over 100 patients. The MGH angiolytic laser treatment is an important and effective new option for treating vocal cord cancer since until now 90 percent of patients have received standard radiation
treatment which can damage normal vocal cord tissue and impair the voice.
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After being interviewed by Matt Lauer on the Today Show on October 19, 2007, Steven Tyler and Dr. Steven Zeitels were featured on Sunday, October 21, on the National Geographic Channel (NGC), which presented the "Incredible Human Machine," This two-hour documentary is a journey through an ordinary and extraordinary day-in-the-life of the human machine. With stunning high-definition footage, radical scientific advances and powerful firsthand accounts, Incredible Human Machine plunged deep into the routine marvels of the human body.
Striking feats of medical advancements are demonstrated, including Dr. Zeitels' digitally-recorded laser surgery on Steven Tyler and real-time measurement of the rocker's vocal cords during a live concert. Aerosmith's lead singer Steven Tyler opens wide and gives us an intimate endoscopic look at how his famous pair of vocal cords holds up to the trauma of singing his signature song, "Dream On."
After vocal damage forced him to cancel part of the band's tour, a pioneering laser method of "zapping" the damaged blood vessels with a pulsed KTP laser allowed Tyler to start singing again. The real-time monitoring of Tyler's voice during the live concert was accomplished with new technology developed by a research team led by Dr. Hillman. These measurements reflected the tremendous strain that Tyler places
on his vocal system during a performance, often exceeding 110 decibels in loudness, with his vocal cords colliding more than 750,000 times during the 90 minute concert.
Dick Vitale, who was recently accepted into the College Basketball Hall of Fame for being its premier broadcaster, underwent vocal cord surgery by Dr. Zeitels
for precancerous dysplasia. Mr. Vitale was brought to Dr. Zeitels by his Otolaryngologist in Florida, Dr. Daniel Deems, because of the ground-breaking advancements by the MGH team in restoring voices, especially in those patients with precancerous and malignant vocal cord lesions. Mr. Vitale's treatment has been very successful and recently returned to announce the Duke - North Carolina game.
Later that week Drs. Hillman and Zeitels were hosted by Mr. Vitale and ESPN in Louisville for their contest with Georgetown. At that game, Vitale's voice was monitored with an invention developed by Dr. Hillman's research team and previously used to assess Steven Tyler for the National Geographic Channel documentary.
The events related to Mr. Vitale's voice surgery were covered extensively in sports pages throughout the country including the New York Times, Associated Press, and USA today. Zeitels was described by Vitale as "the Tom Brady of the voice surgery."
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(Reprinted with permission from The Wall Street Journal)
By Zachary M. Seward
Wednesday, August 16, 2006
Boston – STEVEN TYLER, the rock star and lead singer for Aerosmith, lay on an operating table at Massachusetts General Hospital in March, a thin laser snaking through his iconic mouth and down into his legendary pipes.
Nearly six months into a North American tour, a popped blood vessel on Mr. Tyler's right vocal cord had reduced his singing voice to a hoarse shrill and forced Aerosmith to cancel all 20 of its remaining concerts. The injury was a potential disaster for Mr. Tyler, whose hot-blooded, high-pitched tones have defined his 33-year career. Even the slightest tweak in his throat – the stiffening of a vocal cord or a change in its vibration – could have forever altered the sound of "Walk This Way," his signature tune.
How Mr. Tyler, 58, reacquired his voice, signature squawks and all, could have broad implications for professional singers silenced by vocal disorders. He was treated with a pulsed potassium-titanyl-phosphate (KTP) laser, the latest and most promising procedure to come out of Mass. General's voice center.
Quick bursts of green laser light, lasting just 15 milliseconds, zapped Mr. Tyler's broken blood vessel, sealing the vessel without touching it. But now, almost five months after his experimental surgery, he declares, "Oh, I'm back in action." He proves it with a series of wild, cascading scales. "I can do the whole Janis Joplin thing," he says. Mr. Tyler had to rest his vocal cords after the surgery ("The hardest thing was not talking for three weeks," he says), but he's working full-time now. Aerosmith has been recording in the studio this month, and a new gig, "The Route of All Evil Tour" with Moetley Crue, began on September 5.
The procedure is sounding a positive note for more successful and resilient recoveries from vocal disorders like Mr. Tyler's. It has saved the voices of at least 14 other singers since 2005, including the opera star Carol Vaness.
A paper published last week by Steven M. Zeitels in the Annals of Otology, Rhinology & Laryngology (that would be ear, nose and throat) reports effective and "relatively safe" treatments in 39 singers, using the pulsed- KTP laser in some cases and an earlier incarnation, a yellow-light laser, in others. "This is profoundly affecting the way we treat vocal disorders," says Dr. Zeitels, who performed the surgery on Mr. Tyler.
A dermatologist at Mass. General, R. Rox Anderson, first developed the use of a pulsed laser for treating port-wine stains on baby skin. The laser heated the blood causing the stain without stiffening the delicate baby skin around it. Dr. Zeitels then applied the same concept to the vocal cords. Dr. Zeitels believes he's the only one using the pulsed-KTP laser on the vocal cords.
The National Institutes of Health estimates that 7.5 million Americans have trouble using their voice, with disorders ranging from spasms to tumors. Singers, who use their voices constantly with little rest, are at the highest risk. Greater touring demands have increasingly strained voice boxes in genres from opera to hip hop. And the belting, wailing, and screeching common among some singers, especially in hard rock and heavy metal, have led to still further woes.
Canceled appearances, delayed albums and shortened careers can frustrate both aartists and their fans. Just this week, Mick Jagger was forced to cancel two Rolling
Stones concerts in Spain after coming down with laryngitis, the band said.
"Just like athletes, singers need to have adequate rest," says Jan Shapiro, chair of the voice department at Berklee College of Music in Boston. "Opera singers hitting high notes, even students practicing every day, that takes its toll. We see all sorts of voice problems and more now than ever."
The offices of Mass. General's voice center, which has emerged as the nation's pioneer in the treatment of vocal disorders, are a testament to its range of high-profile patients. Signed head shots of such artists as Ozzie Osborne and Cher line the wall. A photo features Sen. John F. Kerry, who lost his voice in losing the 2004 presidential election. Another shows a smiling Jack Welch, former chief executive of General Electric Co.
The dominant treatments for broken blood vessels in the larynx have traditionally been cauterization and removal with surgical tools. But both methods carry a high risk for altering the vocal cords, or vocal folds, as they are clinically known, by applying excess heat and leaving them stiff.
In Mr. Tyler's operation, the goal "was to get the vessel to seal without getting heat outside the vessel," Dr. Zeitels says. "It's the heat outside the vessel that causes stiffening in the vocal folds."
Dr. Zeitels has used the laser to treat not only broken vessels, but also dilated veins, polyps and precancerous lesions known as dysplasia. The laser interrupts the blood supply that such disorders depend on to thrive. Many of the procedures can be performed in his office with just local anesthesia. The main risk is surgical error, since the treatment area is so small. The treatment is not just for singers, either. "We get professors, CEOs, anyone who's using his voice all day without much rest for years and years," says Robert E. Hillman, research director at the voice center. They have also begun using the pulsed-KTP laser on laryngeal cancer, helping to avoid radiation treatment or removal of the larynx.
John Ward, a business professor at Northwestern University, developed two cancers on his vocal cords, and many doctors said he would have to undergo radiation, which causes scarring and can only be used once. But in three surgeries over several months, Dr. Zeitels was able to remove the larger tumor and eliminate the other by cutting off its blood supply with the yellowlight laser. That saved Prof. Ward's voice, and he continues to give lectures and coach his child's soccer team.
Almost four years later, Prof. Ward is considered cured and says in a raspy but healthy voice, "Dr. Zeitels not only saved my life but my career as well." The experience led Prof. Ward to help form the Voice Health Institute, which has raised more than $5 million for the Mass. General voice center in three years.
That money, along with funding from the hospital itself, has allowed Dr. Zeitels to expand his practice into a full-blown research center, by far the world's largest in laryngeal surgery. The center is equipped with two advanced sound rooms, not unlike a recording studio, where doctors can make precise measurements of voice quality and lung pressure for comparison after treatment. A speech pathologist at the center, who is also a classical singer, outfitted her own examination room with a grand piano.
The center also provides continuing medical education classes for laryngologists and surgeons, sometimes presenting live demonstrations of the pulsed-KTP laser treatment. One video shown to doctors features a view of Mr. Tyler's vocal cords, healed after surgery, as he sings Aerosmith's 1973 smash "Dream On" with his customary verve. The twin folds of mucous membrane vibrate violently over his larynx as Mr. Tyler hits the chorus, "Sing with me, sing for the years…"
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