First pediatric laryngeal reinnervation surgery in Iowa gives 5-year-old Crystal her voice

From the time she was a toddler, Crystal Rush couldn’t speak normally because of nerve damage that kept her voice box from closing properly.

Crystal remained shy and spoke very quietly—barely loud enough to hear—and often used hand gestures instead of talking to communicate.

Last July, UI Stead Family Children’s Hospital pediatric otolaryngologist Sohit Kanotra, MD, used a procedure never before performed on a pediatric patient in Iowa—laryngeal reinnervation surgery—to repair Crystal’s damaged nerve.

Now, at age 5, Crystal speaks more clearly and can communicate normally and confidently.

“She’s a lot happier,” says Crystal’s mother, Cassie Johnson, of Cedar Rapids, Iowa. “It’s a blessing the way that she can talk now.”

Nerve damage caused multiple issues

Crystal’s vocal difficulties began when a nerve connected to her voice box was damaged during cardiac surgery performed at her local hospital. The nerve damage paralyzed a vocal cord, and her voice box couldn’t close fully. Her voice became soft and low-pitched.

“She just pointed at things and whined for what she needed,” Cassie says.

The nerve damage also led to significant gastrointestinal challenges that left Crystal underweight.

“One of the things that can happen with children, if they cannot close their voice box completely, is that whenever they try to eat, they might aspirate because the food can go down the windpipe rather than the food pipe,” Kanotra says. “That can cause the child to have difficulty with eating.”

Advanced care for children with breathing, swallowing, and voice issues

Kanotra oversees the new Pediatric Aerodigestive Program at UI Stead Family Children’s Hospital. The program draws on the expertise of specialists in otolaryngology, pulmonology, and gastroenterology.

The program delivers advanced care and the latest treatments for children with breathing difficulties, including children who have tracheostomies, along with children with swallowing concerns and children like Crystal who have voice issues.

“It’s a significant program,” Kanotra says. “I want parents in Iowa to be aware of all that we’re doing so that if they need these services, they know they don’t need to go far. We are here to provide them.”

‘Like an altogether different child’

During the procedure, Kanotra connected a functioning nerve in Crystal’s neck to the injured nerve in her voice box. Just a few months after her surgery, Crystal was thriving physically and emotionally and making herself heard.

“Crystal is doing amazingly well,” Kanotra says. “Now her mother says she can hear her from across the street.”

She also eats well and has gained four pounds.

Cassie says she’s grateful for more than the advanced technique. She also appreciates the care that Kanotra provided throughout the whole experience.

Kanotra says that watching Crystal develop into the child she was always meant to be is what makes his work so rewarding.

“When I first met Crystal, she was so shy,” Kanotra says. “But when I saw her for a checkup recently, she was talking so much. She’s like an altogether different child.”