Pioneering artificial tongue gives scientist power of speech

A scientist passed her PhD and can talk more easily to family and friends thanks to a new prosthetic tongue.

Imogen Brooks is believed to be the first person in the UK to get a bespoke artificial tongue on the NHS after she had months of treatment for cancer at Guy’s and St Thomas’.

Imogen was 26 when she was diagnosed with a squamous cell carcinoma, which is the most common type of head and neck cancer. Surgery to remove the tumour took out almost all of her tongue. While Imogen’s speech was good after a reconstruction, subsequent radiotherapy significantly shrank the new tongue tissue.

Despite intensive speech and language therapy as part of her extensive recovery, it was difficult for Imogen to speak in a way she was easily understood by strangers, which brought challenges for her professionally and personally.

Imogen, now 30, from Newham in east London, had to use speech assistance technology on phone calls. Acquaintances and past colleagues would avoid speaking to her because they were worried they couldn’t understand her well.

Imogen said: “My speech had a huge impact on my quality of life. Professionally, it ruined my self-confidence. I felt less independent. I knew I had a lot of value to contribute, but I wasn’t able to do that because there was a lot of variability in how people could understand me. People would hear me speak and look at me nervously.”

Having read academic journal papers on prosthetic tongues, Imogen asked her clinician at Guy’s and St Thomas’ if she would be a candidate for one.

Carolyn Doughty, advanced specialist speech and language therapist at the Trust, brought together a multi-disciplinary team from restorative dentistry, including doctors and laboratory technicians, to make her a new tongue.

Carolyn, Imogen’s lead clinician after her surgery and radiotherapy, said: “As a scientist, Imogen had done her own research about a custom-made tongue prosthesis and asked if that could be done for her. I spoke to our oral surgery team and they were happy to make a prosthesis for her to optimise her speech.”

Imogen said:

It was like assembling the Avengers. At my next appointment there were 8 people in the room. Everyone was willing to try.

Months of scanning, research and development of prototypes led to the team creating 2 trial tongues before refining a final version. This has a U-shaped metal cobalt chrome framework which clips onto Imogen’s bottom teeth, and a fixed silicone tongue which has been carefully made to her individual needs.

Michael Brown, dental technician at Guy’s Hospital, said: “We knew Imogen really wanted to speak, so this tongue had to be functional.

"We’d never made  something like this before, but our team loves a challenge. We based the design on a shape which would allow Imogen to make the maximum number of sounds.

“There was a lot of trial and error in finding a shape that would work. Imogen would work with Carolyn on making sounds with her prototype prosthesis. Then she would take home a design, try it out and come back to us with lots of notes. It has been so satisfying to have worked with Imogen through this.”

Imogen has worked tirelessly throughout the process, learning to move her mouth, jaw and new tongue in ways to improve her speech, and re-open doors to the rest of her life.  She said: “Within 2 weeks of getting my tongue, I was pretty much acclimatised.

Even within 3 days of wearing the prosthesis I had such a strong improvement. The development in my ease and intelligibility of speaking was rapid.

With her prosthesis, Imogen has passed an oral exam for her doctorate in skin disease therapies at King’s College London, and has a new job as an assistant medical writer.

One of Imogen’s most poignant moments with her new tongue was speaking to her grandmother.

Imogen said: “My grandmother is hard of hearing, and I had so much difficulty communicating with her after my surgery and radiotherapy. After I got the new tongue, I visited her and she said it was so much easier to understand me with the prosthesis. It was very moving.”

Carolyn added: “It’s amazing to hear Imogen speak now – she has worked so hard to get the most from this artificial tongue, and we’re all incredibly proud of her.”

Jose Rodriguez, consultant in restorative dentistry, and Surina Bhola, senior speciality registrar, worked with the wider team to create Imogen’s new tongue.

Surina Bhola said: “We felt a personal responsibility to ensure we tried our absolute best for Imogen, and although this prosthesis was new to us, we applied basic principles and took inspiration from our colleagues internationally to think outside the box. Imogen’s progress has been inspiring, and we are very lucky she was so motivated and trusted us to find her a solution.”

Jose Rodriguez said: “This is the sort of pioneering, multi-speciality work we pride ourselves in doing. Patient centred, thinking differently, and working as a team with no barriers for a hugely successful outcome for Imogen.”