The sound of resilience: A UAB patient’s journey from silence to song

After two and half years of not having a voice, Deborah Hays Emanuel can now sing her song of resilience thanks to the UAB Voice Clinic.
Written by: Madeline Hand
Media contact: Brianna Hoge

inside deborah hays voice clinic 231116 001 4122Deborah Hays Emanuel
Photography: Andrea Mabry
For two and a half years, Birmingham resident Deborah Hays Emanuel experienced the physical and psychological adversity of having a non-functional voice following an intubation injury that severely damaged the vibratory layer of both her vocal folds during a procedure.

Many patients who suffer from inadvertent vocal cord injuries from routine intubations are simply told to give up hope, despite the efforts of many surgeon-scientists today, as there is no confirmed cure. But thanks to a University of Alabama at Birmingham physician, Emanuel would soon find her sound of resilience.

Sound of silence

“After my surgery, I woke up with pain but could not tell where the pain was coming from. My neck was aching, and they told me that it could be from the strain on my vocal cords,” Emanuel recalled. This would be the first day of what would become a multi-year struggle to regain her ability to effectively communicate aloud.

She was referred to a specialist and underwent multiple treatments and voice therapy sessions. When she opened her mouth to speak, Emanuel could not make a sound above a whisper, and even a whispered sentence strained her voice so much that it would often lead to painful coughing fits.

Her quality of life diminished as she was no longer able to sing in her church choir, actively participate in conversations or talk on the phone. However, the hardest aspect was her inability to speak to her loved ones. Emanuel recalls a solemn memory of when her young grandchild asked if she would be able to hear her grandmother’s voice ever again.

Battling conflicting feelings of hopelessness and desperation, she knew she did not want to go the rest of her life without a voice and was determined to find a solution. Emanuel was referred to the care of laryngologist Bharat Panuganti, M.D., who had recently joined the UAB Voice Center, a division in the Department of Otolaryngology.

Sound of resilience

After a consultation, Panuganti and his team decided to try a series of subepithelial dexamethasone injections to lift her epithelium tissue, one of the four main tissues in the body. This was in effort to allow re-distribution of the superficial lamina propria tissue into regions of her vibratory layer that were destroyed.

“Surgical rehabilitation of the voice in situations where the vibratory layer of the vocal fold is lost is an extremely challenging proposition,” said Panuganti, assistant professor in the UAB Marnix E. Heersink School of Medicine. “There is no existing injectable that reliably emulates the mechanical properties of the superficial lamina propria.”

But to Emanuel's delight, after four injections, her granddaughter and loved ones got to hear her voice for the first time in over two years.

“Many people take having a voice for granted. You don’t know how important something is until you lose it,” she said. 

When asked what she would recommend to others suffering from voice loss, she emphasized to never give up hope and to find the right doctor who fits individual needs.

“In Deborah’s case, and in the few patients in whom we have tried the technique, it has worked exquisitely well,” Panuganti said. “We believe, for patients who have suffered injury to the vocal folds, there may be a technically straightforward method to optimize their voice that does not require experimental or exogenous medical treatments, but a simple application of voice biomechanics and physiology.”

From silence to song

Today she upholds her voice health by drinking plenty of fluids and practicing singing scales, and she will most likely continue to undergo maintenance voice therapy. Emanuel rejoined her church choir and is attending weekly rehearsals in anticipation of their upcoming holiday performance. She says her journey is a melody of both personal perseverance and the care given by providers at UAB who believed in her recovery.