Following surgical resection and stereotactic radiation therapy to treat a metastatic adenocarcinoma in his left cerebral hemisphere, Dick Smith’s voice was inexplicably reduced to a whisper. “Between his brain surgery in July and the Gamma Knife treatment in mid-August, Dick had lost so much of his voice that we gave him the nickname Whispering Smith,” says his wife, Jackie Smith. “When we decided to track the origin of his problem, Neurosurgery referred us to a laryngologist, who discovered that Dick’s right vocal cord was paralyzed.”
The physician whom they saw was Ronda Alexander, MD, a fellowship-trained laryngologist at Texas Voice Performance Institute at The University of Texas Medical School at Houston and Memorial Hermann-Texas Medical Center. Dr. Alexander specializes in evaluation of hoarseness, spasmodic dysphonia, vocal tremor, vocal cord paralysis, extra-esophageal reflux, and swallowing disorders.
She recommended injection medialization laryngoplasty, which increases the bulk of the vocal folds and improves glottic closure. “For his injection, we used Radiesse®, which is composed of hydroxyapatite spherules in a gel carrier,” she said. “It’s a simple procedure that provides immediate, concrete results. In patients like Mr. Smith who have other health concerns, being unable to speak limits their ability to advocate for themselves as they navigate the healthcare process.” While the procedure can be performed in the physician’s office, the Smiths opted to have it done under general anesthesia in the Ambulatory Surgery Center at Memorial Hermann-TMC.
Injection medialization may need to be repeated. “In some patients an injection may provide clinical benefit for as long as two years,” said Dr. Alexander, who is an assistant professor in the Department of Otolaryngology-Head and Neck Surgery at the UT Medical School. “It provides a very good temporary solution in certain cases until we can locate the cause of voice loss and find a more permanent resolution, if applicable.”
The Smiths were pleased with the results. “Dick’s voice is a little gruff, but he can talk with family, friends, and his doctors,” Jackie Smith said. “Dr. Alexander is truly amazing. She gives you her complete attention and makes you feel like she has all the time in the world.”
For more information about the Texas Voice Performance Institute, please visit www.texasvoice.org.
To refer a patient to Dr. Alexander, please call 713.486.5000 or visit www.ut-ent.org.