John Frazer, a recent retiree who lives in Hobe Sound, Florida, has used his voice for public speaking ever since college. Through jobs ranging from a radio announcer to a management

consultant to a charter boat captain, he’s engaged countless listeners and clients. So, when he noticed that his voice began to sound hoarse, he sought out medical advice right away.

Then living in Antigua, he visited a local clinic. After a biopsy, a doctor there diagnosed him with laryngeal dysplasia, a condition in which cells on the surface of the voicebox develop a patina of precancerous cells that can progress toward cancer if they’re not removed.

Frazer visited hospitals in London and North Carolina, receiving surgeries at both to remove this layer of cells. However, eventually doctors told him that there was nothing else they could do. Because the dangerous cells kept returning, he’d need chemotherapy and radiation to prevent cancer, treatments that would inevitably take away his voice.

“It was devastating to hear that,” Frazer remembers. “I’m a talkative and outgoing person, and it’s the loneliest feeling in the world to think about losing my voice.”

Seeking another opinion, Frazer met with Johns Hopkins otolaryngologist–head and neck surgeon Lee Akst, an expert in laryngeal dysplasia.

“For this condition,” Akst says, “it’s critical to balance preventing a progression toward cancer with helping patients keep their voices. Losing their voices isn’t inevitable, and we’ve crafted unique protocols that can help many patients maintain voice quality over time.”

After giving Frazer a stroboscopy, a video examination of the vocal cords that’s only available at specialty centers such as Johns Hopkins, Akst confirmed that many other hospitals would recommend chemotherapy, radiation, or even removing the voicebox to prevent the precancerous cells from returning. But Akst had a different plan: He suggested a precise laser surgery that removes just the surface cells from the inner voice box, preventing the formation of scar tissue that would harm voice quality.

After his initial surgery with Akst in September 2011, Frazer has returned more than a dozen times for subsequent surgeries, seeing Akst and his team every three to four months as his precancerous cells return. Frazer’s case is unusual, Akst explains. Some patients with laryngeal dysplasia never have a relapse after treatment; others require follow-up treatments years later.

But Akst notes that even with his necessary and frequent retreatments, Frazer’s voice has remained strong and steady. “Almost anywhere else I can imagine,” Akst says, “a patient who’s received this many operations on his voicebox wouldn’t be speaking right now. It’s a testament to our protocol that his voice hasn’t been compromised.”

Because of this success, Frazer says, he plans to continue returning to Johns Hopkins every few months for new treatments. “My voice has always been a large part of my life,” he says, “and thanks to Dr. Akst, I get to keep it.”