World Street Journal

Rock's best laser light show is in Steven Tyler's throat

(Reprinted with permission from The Wall Street Journal)
By Zachary M. Seward
Wednesday, August 16, 2006

Boston – STEVEN TYLER, the rock star and lead singer for Aerosmith, lay on an operating table at Massachusetts General Hospital in March, a thin laser snaking through his iconic mouth and down into his legendary pipes.

Nearly six months into a North American tour, a popped blood vessel on Mr. Tyler's right vocal cord had reduced his singing voice to a hoarse shrill and forced Aerosmith to cancel all 20 of its remaining concerts. The injury was a potential disaster for Mr. Tyler, whose hot-blooded, high-pitched tones have defined his 33-year career. Even the slightest tweak in his throat – the stiffening of a vocal cord or a change in its vibration – could have forever altered the sound of "Walk This Way," his signature tune.

How Mr. Tyler, 58, reacquired his voice, signature squawks and all, could have broad implications for professional singers silenced by vocal disorders. He was treated with a pulsed potassium-titanyl-phosphate (KTP) laser, the latest and most promising procedure to come out of Mass. General's voice center.

Quick bursts of green laser light, lasting just 15 milliseconds, zapped Mr. Tyler's broken blood vessel, sealing the vessel without touching it. But now, almost five months after his experimental surgery, he declares, "Oh, I'm back in action." He proves it with a series of wild, cascading scales. "I can do the whole Janis Joplin thing," he says. Mr. Tyler had to rest his vocal cords after the surgery ("The hardest thing was not talking for three weeks," he says), but he's working full-time now. Aerosmith has been recording in the studio this month, and a new gig, "The Route of All Evil Tour" with Moetley Crue, began on September 5.

The procedure is sounding a positive note for more successful and resilient recoveries from vocal disorders like Mr. Tyler's. It has saved the voices of at least 14 other singers since 2005, including the opera star Carol Vaness.

A paper published last week by Steven M. Zeitels in the Annals of Otology, Rhinology & Laryngology (that would be ear, nose and throat) reports effective and "relatively safe" treatments in 39 singers, using the pulsed- KTP laser in some cases and an earlier incarnation, a yellow-light laser, in others. "This is profoundly affecting the way we treat vocal disorders," says Dr. Zeitels, who performed the surgery on Mr. Tyler.

A dermatologist at Mass. General, R. Rox Anderson, first developed the use of a pulsed laser for treating port-wine stains on baby skin. The laser heated the blood causing the stain without stiffening the delicate baby skin around it. Dr. Zeitels then applied the same concept to the vocal cords. Dr. Zeitels believes he's the only one using the pulsed-KTP laser on the vocal cords.

The National Institutes of Health estimates that 7.5 million Americans have trouble using their voice, with disorders ranging from spasms to tumors. Singers, who use their voices constantly with little rest, are at the highest risk. Greater touring demands have increasingly strained voice boxes in genres from opera to hip hop. And the belting, wailing, and screeching common among some singers, especially in hard rock and heavy metal, have led to still further woes.

Canceled appearances, delayed albums and shortened careers can frustrate both aartists and their fans. Just this week, Mick Jagger was forced to cancel two Rolling Stones concerts in Spain after coming down with laryngitis, the band said.

"Just like athletes, singers need to have adequate rest," says Jan Shapiro, chair of the voice department at Berklee College of Music in Boston. "Opera singers hitting high notes, even students practicing every day, that takes its toll. We see all sorts of voice problems and more now than ever."

The offices of Mass. General's voice center, which has emerged as the nation's pioneer in the treatment of vocal disorders, are a testament to its range of high-profile patients. Signed head shots of such artists as Ozzie Osborne and Cher line the wall. A photo features Sen. John F. Kerry, who lost his voice in losing the 2004 presidential election. Another shows a smiling Jack Welch, former chief executive of General Electric Co.

The dominant treatments for broken blood vessels in the larynx have traditionally been cauterization and removal with surgical tools. But both methods carry a high risk for altering the vocal cords, or vocal folds, as they are clinically known, by applying excess heat and leaving them stiff.

In Mr. Tyler's operation, the goal "was to get the vessel to seal without getting heat outside the vessel," Dr. Zeitels says. "It's the heat outside the vessel that causes stiffening in the vocal folds." Dr. Zeitels has used the laser to treat not only broken vessels, but also dilated veins, polyps and precancerous lesions known as dysplasia. The laser interrupts the blood supply that such disorders depend on to thrive. Many of the procedures can be performed in his office with just local anesthesia. The main risk is surgical error, since the treatment area is so small. The treatment is not just for singers, either. "We get professors, CEOs, anyone who's using his voice all day without much rest for years and years," says Robert E. Hillman, research director at the voice center. They have also begun using the pulsed-KTP laser on laryngeal cancer, helping to avoid radiation treatment or removal of the larynx.

John Ward, a business professor at Northwestern University, developed two cancers on his vocal cords, and many doctors said he would have to undergo radiation, which causes scarring and can only be used once. But in three surgeries over several months, Dr. Zeitels was able to remove the larger tumor and eliminate the other by cutting off its blood supply with the yellowlight laser. That saved Prof. Ward's voice, and he continues to give lectures and coach his child's soccer team.

Almost four years later, Prof. Ward is considered cured and says in a raspy but healthy voice, "Dr. Zeitels not only saved my life but my career as well." The experience led Prof. Ward to help form the Voice Health Institute, which has raised more than $5 million for the Mass. General voice center in three years.

That money, along with funding from the hospital itself, has allowed Dr. Zeitels to expand his practice into a full-blown research center, by far the world's largest in laryngeal surgery. The center is equipped with two advanced sound rooms, not unlike a recording studio, where doctors can make precise measurements of voice quality and lung pressure for comparison after treatment. A speech pathologist at the center, who is also a classical singer, outfitted her own examination room with a grand piano.

The center also provides continuing medical education classes for laryngologists and surgeons, sometimes presenting live demonstrations of the pulsed-KTP laser treatment. One video shown to doctors features a view of Mr. Tyler's vocal cords, healed after surgery, as he sings Aerosmith's 1973 smash "Dream On" with his customary verve. The twin folds of mucous membrane vibrate violently over his larynx as Mr. Tyler hits the chorus, "Sing with me, sing for the years…"

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