Who’s speaking?

First published in the NASGP Newsletter on 28th February 2022

Remember Billroth I and II? But Theodore Billroth wasn’t just a pioneering gastric surgeon. He successfully performed the first total laryngectomy in 1873. He was also a talented musician and a friend of Johannes Brahms, who sought his opinion on his latest compositions.

Soprano Gweneth-Ann Rand knows what it’s like to face voice-threatening throat surgery. Fortunately, the operation on her throat tumour left her vocal cords intact. At a concert she gave last May, after the applause, we in the audience were asked to stay in our seats for a surprise. A woman called Sara came on stage. She put her finger over her laryngectomy stoma and she and Rand sang Sara’s poem ‘Can you Hear my Voice?’, set to music by composer Hannah Conway. Sara felt she not only lost her voice, she lost part of her identity. Could she still express herself? Was she the same person?

Romantic lead? Screen villain? Our voices tell others so much about us. How do we respond to changed voices? To artificial voices? Do you swear at your satnav? Are you irritated by Alexa? Standing on the station platform, how much confidence do you have in loudspeaker announcements?

The BBC R&D unit is creating a library of all the sounds of normal speech. That isn’t straightforward. Give any non-professional a passage to read and it won’t sound genuine. Every patient we see has different ‘normal speech’. So, thousands of sounds must be fed into the sophisticated computer programme which generates an infinite number of words and sentences.

These synthetic voices are then tried out on the public. Disembodied artificial voices can arouse strong emotions, just as real voices do. You may not propose marriage to Alexa but she’s ‘human’ enough that saying hullo to her is almost a reflex. Though she can be very trying. Would we find computer-generated voices less irritating if they were more human? Or less?

What voices do we feel are appropriate for what use? An announcement of a plane crash on national news demands a different tone from a local radio station listing local garden fetes. And would an artificial voice with the same honest Scots accent seem equally trustworthy?

Our identity is our voice. It tells others a lot about us, though not always exactly who we are. When my sister and I shared a flat our father could never tell us apart on the phone and would fish for clues while we teased him.

We adjust to changed strange voices, even synthetic ones. When Stephen Hawking was offered a more lifelike voice he opted to retain the one he had used for years; however unnatural, it had become ‘his’ voice.

As we age the pitch of our voice drops. Our delivery slows and becomes breathy because the muscles which close our vocal cords are weaker. Watch one of David Attenborough’s recent programmes. They include clips from programmes he made years ago. Compare his 95-year-old’s voice with his younger self. Or compare the Queen’s Christmas broadcasts over the years.

But a laryngectomy is different. How do you rebuild your life? The post-op therapists may enable you to produce some sort of voice, fellow-sufferers will share experience and tips, but when speech is a struggle it’s hard to process the burden of loss.

Opera meets biomedical research.

Shout At Cancer, founded by Dr Thomas Moors, uses singing and acting and ultimately public performance to restore not just the voice but also the confidence that laryngectomy takes away.

Hannah Conway’s Sound Voice investigates voice, its role in our identity and the experience of losing it. She describes it as ‘opera meets biomedical research’. People who live with voice loss, and their families, come together with musicians, therapists, medics, scientists and engineers working on re-creating larynxes. Sound Voice has created an intriguing 25-minute video installation which presents an audio-visual of performances by Paul, Tanja and a Shout at Cancer choir.*

Paul, who has motor neurone disease, says he felt like a monk who had taken a vow of silence until he stood on stage and sang with baritone Roderick Williams. He extended Paul’s struggling words and gave them operatic fluency.

Tanja only had a week to prepare for her laryngectomy, so she made a video for her small children. She knows she will sound different. She won’t be able to chat with them while she is eating, sing to them or laugh, or call out the moment they appear to be in danger. In their duet, soprano Lucy Crowe projects these anxieties, while Tanja’s new voice sings that she is still mummy and loves her kids as much as she ever did.

There are choirs throughout the country for people with any condition which weakens the strength of the voice. If you have Parkinson’s Disease how much easier it must be to initiate voluntary movements when you are singing with others. And how much pleasure it must give.

I cannot forget the first patient I saw when I started my first house-job. He was dying of throat cancer. His trachy filled up with mucus, he was very weak and he couldn’t speak, but his overwhelming fear was obvious. I felt powerless to help him. Most of the 35,000 new head and neck cancer diagnoses per year in UK are laryngeal cancers, and the incidence has increased by a third in the last 25 years, more in women, and deprivation is a risk factor. It isn’t just the patients who have to come to terms with voice loss; it’s a challenge for all of us.

Hannah Conway hopes that galleries and public spaces and healthcare settings will use the Sound Voice’s installation to stimulate interest and more understanding of what it means to lose your voice. For more information see soundvoice.org.

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