MGH researchers report successful new laser treatment for injured singers

Patients treated include Aerosmith's Steven Tyler, who has returned to performing

A new type of laser for voice surgery (phonosurgery), utilized for the first time at Massachusetts General Hospital (MGH), has allowed Aerosmith singer Steven Tyler to resume performing after a tour-ending vocal injury. Recently, he and Aerosmith guitarist Joe Perry headlined the annual Boston Pops July Fourth Esplanade concert.

Earlier this year Tyler, an icon in rock music, sustained bleeding into a vocal cord. Years of athletic vocal performance had led to the development of abnormal blood vessels that were predisposed to further injury. In March, Aerosmith's current tour was cancelled so that Tyler could have his traumatized vocal-cord vessels surgically treated by Steven Zeitels, MD, director of the MGH Voice Center. Tyler has recovered from the procedure, and the band is currently recording prior to their upcoming tour, which gets underway in September.

Zeitels explained,

" We previously adapted lasers that target blood vessels for use in the treatment of precancerous vocal-cord dysplasia. We then applied that experience to institute a new treatment strategy for one of the most common career-stopping problems in singers, which is vocal-cord bleeding that can also lead to the formation of benign growths such as polyps and nodes (nodules)."
Zeitels is the Eugene B. Casey Chair of Laryngeal Surgery at Harvard Medical School.

A lifetime of singing can place vocalists at increased risk for vocal cord injury, similar to the risk of other injuries faced by high-performance athletes. This risk can occur with any singing style - rock, pop, opera or music theater - and is strongly associated with high-intensity performances. Zeitels has been treating elite singers for many years and was called on to work with Julie Andrews after she lost her singing voice due to a failed surgical procedure. He subsequently has collaborated with Miss Andrews to increase awareness of voice problems and spearhead a research project addressing her type of injury.

In treating Tyler, Zeitels utilized his group's most recent innovation, a pulsed Potassium-Titanyl-Phosphate (KTP) laser. The standard continuous-firing KTP laser has been utilized in the past by surgeons as a tissue-cutting and ablating instrument. The MGH team is the first in the world to treat vocal cords and the rest of the larynx with accurately controlled pulses of KTP laser light. The Pulsed-KTP laser has dramatically elevated the precision and ease of laryngeal surgical procedures by more effectively controlling bleeding while being substantially gentler on the delicate vocal-cord tissue.

In scientific presentations at the American Otolaryngology meetings in May, the MGH researchers reported successful results in treating approximately 40 singers over the past 5 years - including Steven Tyler and Metropolitan Opera star Carol Vaness - with laser technology that targets blood vessels. They also reported another investigation using the Pulsed-KTP laser to treat vocal-cord dysplasia and papillomatosis as an office-based clinic procedure avoiding general anesthesia. This first reliable office-based treatment of these diseases evolved from a close collaboration between Zeitels and colleague R. Rox Anderson, MD, director of the MGH Wellman Center for Photomedicine. Previously the team had established the efficacy of angiolytic (targeting and shrinking blood vessels) lasers in microsurgical treatment of vocal-cord dysplasia with the Pulsed-Dye laser, which was also valuable for treating respiratory papillomatosis.

"The Pulsed-KTP laser is currently the optimal angiolytic laser for vocal cord problems. It has greatly enhanced the precision by which we can perform many voice procedures, both in the operating room accompanied by the surgical microscope and in the office treating chronic laryngeal diseases. The Pulsed-KTP laser is an critical innovation in the instrumentation arsenal of the laryngeal surgeon," said Zeitels.

The MGH and HMS instituted one of the first academic programs in Laryngology in the United States in 1870. The MGH program was discontinued in the 1920s and was reestablished less than two years ago with the philanthropic assistance of the Eugene B. Casey Foundation and the Institute of Laryngology and Voice Restoration, a patient-based organization with the mission to further research, clinical care and education in laryngeal and voice disorders. The current research efforts have been catalyzed by a unique, cooperative, and synergistic effort among these organizations.

Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of nearly $500 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, transplantation biology and photomedicine. MGH and Brigham and Women's Hospital are founding members of Partners HealthCare HealthCare System, a Boston-based integrated health care delivery system.

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