Mark Simpson, Ph.D., speech and swallowing pathologist for the Wayne State University School of Medicine's Department of Otolaryngology and the Barbara Ann Karmanos Cancer Center, is one of the few experts in metropolitan Detroit who helps people regain the power of speech after the removal of their larynx because of cancer.
The larynx, which lies between the trachea and esophagus, prevents the passage of food into the airway as a person swallows. It also regulates the flow of air into the lungs and functions in producing speech. In some circumstances, a person with laryngeal cancer must have the entire larynx removed. In that situation, surgeons must bring the trachea forward and place it on the person's neck to completely separate breathing and swallowing functions.
Dr. Simpson's role comes in after the patient has had surgery. He has been involved with speech and swallowing rehabilitation for almost 40 years, having retired from the John D. Dingell Veterans Administration Hospital in Detroit and then joined Karmanos three years ago. While at the VA in the 1970s, Dr. Simpson worked closely with Eric Blom, Ph.D., who created the Blom-Singer Voice Prosthesis with Marc Singer, M.D., F.A.C.S. Dr. Blom now works with various health centers and universities in the Indianapolis area.
Dr. Simpson recalls a time when voice rehabilitation options for cancer patients were limited.
"When I would enter a patient's room with an electropharynx (a device that creates an electronic-sounding voice), it's not really what they wanted to see," he said. "It was a long time before I could say that this is temporary and that something better is coming."
The Blom-Singer Voice Prosthesis, along with Dr. Simpson's customization talents and one-on-one guidance, allows patients to speak again.
Dr. Simpson works closely with head and neck surgeons and the patients affected by head and neck cancers, as well those diagnosed with brain cancer. He implants a tracheoesophageal voice prosthesis, which restores the ability to speak. The prosthesis comes with a small flapper located on the side of the patient's esophagus that remains closed during swallowing but is pushed open for entrance of air into the upper esophagus for speech production.
Since he is so specialized in what he does, Dr. Simpson spends most of his days in the clinic. He typically spends about 10 one-hour sessions with his patients to help them regain speech. He sees about 15 to 20 new laryngectomy patients each year at Karmanos and has additional laryngectomy patients from other facilities around the state referred to him.
"It isn't that we insert the prosthesis and off they go," he said. "I encourage doctors to refer patients to me even before the total laryngectomy surgery because it is so traumatic to lose the power of speech. We take the time necessary to answer the many questions that they may have and arrange a meeting with an individual who has already undergone this procedure."
Those affected by laryngeal cancer, including other head-and neck-related cancers, are usually those who have been smokers and/or drinkers, those exposed to certain chemicals or those with the human papilloma virus.
Dr. Simpson said that nearly every one of his patients outfitted with a voice prosthesis is successful in learning how to speak again.
"I refuse to accept defeat when it comes to voice rehabilitation," he said. "I develop a close and intensely personal relationship with each and every one of my patients and in the end we become friends."
Nancy Miko, a 64-year-old woman diagnosed with laryngeal cancer in 2001, was able to regain her speech with relative ease after being fitted with a prosthesis by Dr. Simpson. Miko, who lives in Dearborn, Mich., is a retired third grade teacher who taught in the Crestwood Schools district.
"You can't tell a teacher to shut up," she said with a grin. "It was devastating to lose the ability to speak and it was frustrating not to be able to converse in a quick way."
Miko said she suspected something was amiss when after a week of classroom teaching it took the weekend to recover her ability to speak. After meeting with her doctor, she learned that she had cancer. She underwent radiation therapy, but the cancer continued to grow. She then decided on surgery to remove her larynx.
She was then referred to Dr. Simpson by Robert Mathog, M.D., chair of the WSU Department of Otolaryngology-Head and Neck Surgery following the tracheoesophageal puncture procedure he performed on Miko to create an opening in the trachea for the voice prosthesis. Today, Miko's voice is lower in tone but she is easy to understand when she speaks. She credits Dr. Simpson, who she called a "wonderfully dedicated" doctor.
"It was like New Year's Eve, regaining my ability to speak," she said. "It wasn't that bad, learning how to speak again. It depends on how much you're willing to do."
A former smoker, Miko and her husband George now keep themselves healthy with a vegan lifestyle and by growing their own food at home.
Miko also does her part to support other cancer patients by serving as president of the Anamilo Monthly Support Group at Karmanos. The Anamilo Club, one of the nation's oldest support groups, is for laryngectomy patients and their families and friends. It is facilitated by Susan Fleming, Ph.D., adjunct assistant professor in the WSU Department of Otolaryngology. The group meets the second Sunday of each month from 2 to 4 p.m. in the Wertz Classroom at Karmanos' main location, 4100 John R, Detroit. Call 1-800-KARMANOS (1-800-527-6266) to register or for more information.
"Members of the support group are a wealth of information," Miko said. "Family and support are the best therapy you can get. The culmination of the two helps to ensure a more successful recovery."