Surgery May Restore Italian Woman’s Voice

An Italian woman eager for the day she can sing again with her two children has come to Orange County with faith that a UCI Medical Center surgeon can repair her damaged voice.

“My children told me to have the surgery and urged me on by telling me, ‘We want to sing with you when you come back,’ ” said Adriana Cioce, a tour guide in Rome who arrived here last week with her husband. An Italian doctor who specializes in microsurgery also came to observe.

Although Cioce was scheduled for surgery Tuesday to repair a nerve to a vocal cord, a cardiac irregularity prompted doctors to delay the procedure until Friday.

“We were getting ready for surgery when the anesthesiologist discovered she had developed a cardiac irregularity,” said Dr. Roger L. Crumley. “She’s fine. It’s just that a cardiogram consultant said it was better not to perform the surgery Tuesday” or today.

Crumley, who heads the medical center’s department of otolaryngology--head and neck surgery--is a leading surgeon in the field of nerve grafting, a technique he developed to repair damaged larynxes such as Cioce’s.

Cioce, 42, traveled to California with her husband, John Tinto, and Dr. Andrea Ortensi, a noted physician in reconstructive microsurgery at the University of Rome.

Her larynx was injured during a thyroid operation in Italy in 1993, and despite months of speech therapy, Cioce has not been able to fully recover.

“My speech is giving me a lot of trouble,” Cioce said. “Some days, my voice is OK, other days it isn’t. The voice is just not in control.”

Tinto said that when Cioce speaks for long periods, “her voice will go out. It’s unpredictable.”

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The operation takes about two hours and is simple to describe though complex to perform, Crumley said.

Although he did not pioneer the technique, he performed his first laryngeal nerve graft a decade ago. He has spent more than 15 years developing the procedure and has performed 50 operations on patients in Australia, Japan, Spain, England and the United States.

During the operation, the injured nerve is removed and a nearby nerve is grafted to the remaining healthy portion and to the larynx muscle that helps control the voice.

Although there are alternatives, such as Teflon injection or thyroplasty, Crumley considers grafting best because the larynx is not touched by the surgeon’s scalpel, the process is reversible and phonetic results are superior.

With Teflon injection, the surgeon creates a blob or mass, he said. Thyroplasty creates the same mass but of silicon rubber. Both techniques are designed to push the vocal cord muscles over the midline to meet each other, which is a normal position, he said.

During an earlier thyroid operation, Cioce’s larynx nerve on the right side of her neck was damaged and it left that nerve paralyzed.

Although she can speak, it is a raspy sound and difficult to control, she said. It takes about three months for the nerve to heal, Crumley said, adding that the operation has a 90% success rate.

“While I can’t guarantee that her voice will return to normal,” Crumley said, “there is a better chance with reconstructing the laryngeal nerve.”

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Cioce, who can speak four languages, is a guide in Rome and at the Vatican City. It was the question of her ability to communicate that led her to Crumley.

Ortensi, who works at one of Rome’s medical teaching hospitals similar to the Medical Center, said he took the opportunity to collaborate with Crumley and borrow some of Crumley’s technique to use in Italy.

“Some people thought I was looking for perfection with my voice,” Cioce said. “But you don’t realize how important your voice is, or how frustrating it can be, until you’re not understood.”

After the nerve was damaged, Cioce said she took speech therapy and achieved a level of communicating that some doctors considered good, she said.

“But not good enough to sustain me for the rest of my life,” Cioce said. “Generally, when I work, after 30 to 40 minutes of talking, it becomes worse and impossible to keep a tone. And after a while, even a microphone and loudspeaker is not enough.”