ACTIVE VOICE

When Ray Boyer woke up from neck surgery last year, he felt fine8212;except he couldn8217;t say so. A PR executive in Illinois, Boyer, now...

When Ray Boyer woke up from neck surgery last year, he felt fine8212;except he couldn8217;t say so. A PR executive in Illinois, Boyer, now 60, had undergone surgery for a slipped disc, a result, most likely, of hauling 75-pound bags of equipment for a youth baseball league, he said. During the operation, the nerve leading to the vocal cords was somehow damaged. One vocal cord was paralysed, and his usual baritone was reduced to a weak, breathy whisper. Boyer was told that his voice was likely to return, because the nerve to the vocal cords can sometimes repair itself. But that could take up to a year. 8220;For a PR guy, that8217;s the kiss of death,8221; he said.

He decided to try an immediate, if temporary, solution. Boyer had the paralysed vocal cord injected with a biodegradable gel. The procedure, which can be performed in a doctor8217;s office with local anaesthesia, is gaining ground, experts said. Patients and doctors are realising that people cannot afford to be without their voices, even for a few months.

Paralysis or weakness of a vocal cord can occur when the nerve that supplies it is damaged. This nerve, the recurrent laryngeal nerve, is famously circuitous, looping down into the chest before heading back up to the voice box. This makes it vulnerable to damage from a variety of sources, like chest trauma, benign or malignant tumours, intubation during surgery, injury during surgery on nearby structures like the thyroid or upper spine and some viruses.

Boyer was fully conscious as Brent Richardson, a laryngologist, threaded an endoscope up his nose and down his throat, until the tiny camera hung just above the vocal cords. Richardson asked him to make vowel sounds. 8220;I could see my vocal cords on a 20-inch colour monitor,8221; Boyer recalled. 8220;One was whamming away, and the other was just sitting there doing nothing.8221;

Richardson inserted a needle through the Adam8217;s apple and injected translucent Radiesse Voice Gel into the paralysed cord, causing it to swell. Another temporary material, Cymetra, made from the processed cadaver skin, is used for vocal cord injections, as well as cosmetic procedures.

As Boyer made vowel sounds8212;8221;The doctor said, 8216;Gimme an E!8221;8217;8212;he said he could 8220;feel the strength and timbre returning8221; to his voice. Richardson said an advantage of doing the procedure with the patient awake was tuning the voice in real time.

The injection does not restore motion to the paralysed cord, Richardson said. But plumping it up allows the two cords to meet and give the nonparalysed one a better surface to vibrate against. Within several months, after the gel had been metabolised, Boyer8217;s voice was strong. And he had regained movement of the vocal cord, suggesting the nerve was recovering, Richardson said.

The injection is not necessarily pleasant, however. Joyce Campion, 43, of Los Alamitos, California, said her voice grew raspy and lost its strength over the course of a year until she was given a diagnosis of a paralysed vocal cord. She had an injection of a temporary gel in 2005 and described the experience as horrible. 8220;You8217;re awake and you have to kind of gag and make noises8221; to help the doctor, she said. The effect lasted about six weeks, she recalled.

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Last year, she had a surgical procedure called reinnervation, in which a functioning nerve is attached to the nerve leading to the vocal cord. It is sometimes implanted into muscles of the larynx. Weeks later, her voice began gradually to return.

-AMANDA SCHAFFER The New York Times