The power of the word: new technology will help restore the voice of thousands of patients

In Russia, they began to perform the first operations to restore vocal folds using their own human cells. The method is aimed at regenerating damaged laryngeal tissues. The procedure will restore the ability to speak normally to thousands of patients, experts told Izvestia. Before the advent of this technology, there were virtually no methods in the country to restore its own fabric. However, such an intervention is not suitable for everyone, so before prescribing it, doctors conduct a comprehensive examination of people with a voice disorder.

How to restore the vocal folds

A new technique has been created at the Sechenov University Clinical Center for the treatment of patients with scarring of the vocal folds that occur after injuries, inflammatory diseases or surgical interventions. In such cases, the normal structure of the tissue is disrupted, which leads to a permanent change or loss of voice.

During surgery, an individual biomedical cell product based on mesenchymal stromal cell spheroids is placed in the defect area. Over time, the defect is replaced by the patient's own tissue, the complex natural structure of the vocal fold and, most importantly, its functional properties are restored.

The development was carried out at Sechenov University for several years, from basic research to preclinical testing. Previously, scientists have shown that a bioequivalent formed on the basis of mesenchymal stromal cells is able to restore the structure of the vocal fold and its biomechanical properties, including the ability to vibrate. In preclinical studies, the restored tissue after the application of cellular spheroids was as close as possible to a healthy vocal fold in its organization and mechanical characteristics.

— Cellular spheroids are three—dimensional structures in which cells maintain natural contacts with each other and remain viable longer after implantation. Due to this, they can maintain regeneration processes in the damaged area for a long time. In preclinical studies, this approach has made it possible to achieve the most complete restoration of the structure of the vocal fold and its mechanical properties," said Peter Timashev, Director of the Institute of Regenerative Medicine at Sechenov University, Professor of the Russian Academy of Sciences.

According to him, the technology itself is platform-based: by changing the composition and delivery method, it can be adapted to regenerate various tissues and organs.

— This is a fundamentally new stage for us, because we are no longer talking about preclinical research, but about real patient care. In case of cicatricial changes in the vocal folds, traditional surgery can remove the scar tissue, but not restore its original structure. Here we have another task — to create conditions for the regeneration of our own tissue and restore the ability of the fold to vibrate normally. The quality of the voice depends on this. The first patient has already successfully undergone such an intervention, recovery is progressing well, and the first clinical results confirm the possibility of using the technology in humans," said Mikhail Svistushkin, PhD, Associate Professor of the Department of Ear, Throat and Nose Diseases at the N.V. Sklifosovsky Institute of Clinical Medicine.

To date, three such interventions have been performed, and in all cases positive results have been obtained. The improvement in speech function is noted by the patients themselves, and it is also confirmed by objective assessment methods — acoustic analysis of the voice and studies of the vibrational characteristics of the vocal folds, the university's Clinical Center said.

Before the advent of this technology, patients with scarring of the vocal folds actually had no methods to repair their own tissue. The existing approaches were mainly aimed at restoring its volume.

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This is an important step for Russian regenerative medicine and phoniatry: it's not just about a new surgical technique, but about an attempt to restore the fine structure of the vocal fold, on which the quality of the voice directly depends, said Albert Rizvanov, head of the Personalized Medicine Center of Excellence at Kazan (Volga Region) Federal University. The field of gene therapy is developing in parallel. This is the first clinical application of such technology in Russia, and it is especially important that it can become a platform for the treatment of various damaged tissues.

— The problem of voice disorders is quite common: according to foreign epidemiological data, about 7-8% of adults experience it during the year, although scarring of the vocal folds is a narrower and more severe category of such conditions. They are most often associated with laryngeal surgery, trauma, intubation, inflammatory diseases, radiation treatment, chronic irritation of the mucous membrane, smoking, reflux, and severe vocal stress. This is not a cosmetic problem for the patient: even a slight violation of the elasticity of the fold can lead to persistent hoarseness, rapid fatigue of the voice, loss of range and a serious decrease in the quality of life, especially for teachers, artists, lecturers, doctors, call center operators," the scientist noted.

According to Sechenov University, in Russia, from 5,000 to 15,000 cases of damage to the vocal folds after artificial ventilation are recorded annually. About 5 thousand more such disorders are associated with surgical interventions, and up to 100 thousand patients face pathology due to chronic laryngitis with fibrosis.

A separate group consists of people with laryngeal paralysis, for example, after thyroid surgery, when the recurrent laryngeal nerve is damaged during the intervention. Such people often live for years with hoarseness or almost complete loss of voice, Marina Chumakova, a leading market expert at NTI Helsnet, told Izvestia.

According to her, the appearance in Russia of operations to restore vocal folds using the patient's own cells is really a serious step forward for domestic medicine, which supports the trend towards regenerative solutions. The technology of cellular spheroids fundamentally changes the logic of treatment — instead of compensating for the defect, the body is helped to restore its own tissue.

In order to be able to apply the technology in a specific case, the patient needs to make an appointment for a consultation at the Sechenov University Ear, Throat and Nose Diseases Clinic and undergo an examination. After assessing the condition of the vocal folds, doctors decide whether this recovery technology is suitable for him.​