A majority of funds raised by the Voice Health Institute (VHI) are used to support ground-breaking research that is directed at improving the prevention, diagnosis and treatment of voice and airway disorders. Following are brief descriptions of the major research areas that the VHI has supported.

The VHI has a long-standing history of supporting innovations in the surgical management of cancer of the larynx (voice box) and surrounding regions of the upper airway. Much of this work has been carried out by Dr. Steven Zeitels and his team at the Massachusetts General Hospital. The overall goal of this work is to effectively treat the disease while preserving or improving the voice and/or airway. These efforts have produced new instruments for gaining better access to the larynx and airway during surgery in the operating room (new surgical endoscopes).

Better endoscopic exposure has been coupled with the development of innovative microsurgical techniques (including new types of lasers) that allow for the conservation of non-diseased tissue and reconstruction of the larynx and/or airway to produce better voice and respiratory outcomes. The VHI has also supported the pioneering work of Dr. Zeitels to create office-based laryngeal laser surgery which has revolutionized the management of chronic diseases like dysplasia and respiratory papillomatosis by avoiding the expense and potential morbidity of repeated general-anesthesia procedures in the operating room.

The VHI has been the main source of funding for the Voice Restoration Research Program which is a large collaborative effort between scientists and clinicians at Massachusetts General Hospital, Massachusetts Institute of Technology and Boston University to develop methods for repairing scarred vocal folds.

The leading cause of voice disorders is the loss of pliability in vocal cord tissue due to scarring. Scarring of vocal cords is caused by a variety of conditions including heavy voice use, aging, surgeries and other treatments involving the larynx (eg. radiation therapy for cancer), exposure to environmental irritants and congenital conditions. Such scarring restricts or eliminates the vibration of vocal cord tissue that is essential for the production of human voice.

There is currently no viable method for restoring pliability to scarred vocal-cord tissue.

To solve this problem, researchers from the Massachusetts General Hospital, under the direction of Drs. Steven Zeitels and Robert Hillman, teamed up with scientists from other departments at MGH, Harvard Medical School and Massachusetts Institute of Technology (MIT) to launch a comprehensive multi-disciplinary research project. Other major collaborators include Dr. Robert Langer and his tissue-engineering group at MIT, as well as Dr. Rox Anderson and his laser specialty group in the MGH Wellman Laboratory for Photomedicine.

News conference to announce the start of the Voice Restoration Research Program
(left) Dr. Robert Hillman, PhD, Dr. Rox Anderson, PhD, Dr. Steven Zeitels, MD, Julie Andrews, Dr. Robert Langer, PhD, Dr. James Kobler, PhD (right)

VHI support for the program has enabled the research team to attack the vocal-cord scarring problem at multiple levels. Some members of the team are working on developing vocal cord bio-implants using a variety of natural and synthetic substances that are designed to replace lost pliability. Other members are developing new surgical technologies that are needed to both prepare the vocal cord recipient site and place the implant. Still others are developing innovative approaches for assessing vocal cord function in terms of better imaging to differentiate healthy from scarred tissue, and ways to directly measure vocal cord biomechanical properties to assist implant design and testing.

Success of the program will result in restoring voice to millions of people who are suffering from the problems associated with such voice loss including negative impacts on:

• everyday communication
• psychological well-being
• socio-economic function

The VHI has funded several research projects at the Massachusetts General Hospital (MGH) Voice Center to develop new laser technologies that have been shown to effectively treat dysplasia, cancer and papilloma of the vocal cords while preserving and/or restoring patients' voices. This treatment employs an angiolytic KTP laser which concentrates the laser energy in the diseased tissue 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 diseased tissue while preserving healthy tissue. This new laser technology was pioneered for use in the operating room and outpatient setting by Dr. Steven Zeitels and his team at the Massachusetts General Hospital in collaboration Dr. Rox Anderson of the MGH Wellman Center for Photomedicine.

VHI funding has made possible the development of more effective methods for treating recurrent respiratory papillomatosis (RRP) which is a chronic viral-based disease that can obstruct the airway and/or destroy the voice, and typically requires repeated surgeries under general anesthesia to control it.

The research team at the Massachusetts General Hospital Voice Center has used VHI funding to develop an innovative approach that combines laser-based (photoangiolytic) and drug-based (antiangiogenesis) treatments to increase efficacy of disease remission while preserving and/or restoring the voices of the patients treated. This treatment regimen can be initiated in the operating room and then continued in the outpatient (office) setting thus avoiding the expense and risks (repeated general anesthesia) of repeated procedures in the operating room.

The VHI has funded investigators at the Massachusetts General Hospital to pursue the utilization of cryo-preserved cadaveric blood vessels (e.g. aorta homograft) as a new soft-tissue transplantation substrate for the aerodigestive tract, the genito-urinary systems and complex wounds. This work has already demonstrated excellent results in using the aorta homograft to reconstruct the larynx (voice box) trachea and pharynx. Ongoing work is continuing to explore its use as a patch and reformulated as an injectable paste for soft-tissue expansion, including as a unique injectable to treat vocal cord paralysis.

VHI finding has also supported the work of Dr. Hillman and his team at the Massachusetts General Hospital Voice Center to develop improved methods for assessing vocal function. Such methods are critical for objectively evaluating the voice outcomes associated with all of the new treatment procedures that are developed at the MGH Voice Center, and are also needed to improve the diagnosis of voice disorders.

Two primary areas that have been pursued are:

• the uses of ultra high-speed digital videoendoscopy (up to 10,000 images per second) to more accurately assess vocal cord vibration for voice production and
• the development of wearable portable systems for voice ambulatory monitoring and biofeedback (to assist behavioral voice therapy treatment of voice disorders). Such ambulatory devices are designed to help identify and correct faulty habitual vocal behaviors (e.g., vocal abuse) that cause many of the most common types of voice disorders.