Management of Swallowing and Speaking Problems Associated With Oral, Head and Neck Cancers
Individuals who have oral (mouth), laryngeal (voice box), or pharyngeal (throat) cancers can have difficulty with swallowing food or drinks (dysphagia), changes in the sound of their voice and/or speaking clarity. The amount of difficulty an individual experiences, related to swallow or communication, usually depends upon the size and location of the tumor, the type of medical treatment, and if surgery and/or reconstruction is needed.
Difficulty swallowing food or drinks can include the following:
- out the mouth or throat
- frequent throat clearing
- coughing and/or choking
- pain when swallowing
- change in voice after eating or drinking that sounds wet and gurgles
- shortness of breath
- runny nose
- food or drink coming out of the nasal cavity
Changes in voice or pronunciation of words can also occur. Some patients complain of a lower or hoarse sounding voice, shortness of breath when speaking, a hard time getting voice out or muffled speech. Patients should inform their physician about the occurrence of these symptoms.
The treating physician can refer the patient to see a Speech-Language Pathologist (SLP). These are professionals that are highly trained in evaluating swallowing, speaking and voice problems. They develop individualized therapy programs to improve the ability to eat, drink or communicate. When an individual is diagnosed with a laryngeal or oral cancer, it is helpful to have a swallowing and a speech evaluation performed early in the diagnostic process. It is best to complete an initial evaluation before medical treatment, such as chemotherapy, radiation treatment or surgical intervention occurs.
The SLP may recommend additional tests such as a Modified Barium Swallow Study (MBSS) or a Fiber Optic Endoscopic Evaluation of Swallowing (FEES). Both of these tests are useful to gather information about swallowing and communication skills before medical treatment begins.
A MBSS is a test done in the radiology department by the SLP and Radiologist. Various food textures and liquid consistencies are mixed with barium. The patient consumes food and drink as the SLP and Radiologist assess swallow function by watching a moving x-ray of the food being swallowed. A FEES is performed by a trained SLP who will pass a thin flexible endoscope through one of the patient’s nostrils. The endoscope has a lens that allows the windpipe (larynx) and throat (pharynx) to be directly viewed as food and drink are being consumed.
A MBSS and/or FEES will aid the SLP in providing the patient with specific exercises to perform throughout the medical treatment process. These exercises can help a patient maintain a better sounding voice, best speaking clarity and/or maintain eating/swallowing throughout the course of medical treatment. Additionally, the SLP may suggest modifying the texture of food; thickness of drinks/liquids or teach ways to best posture the head and neck so that it is easier and safer to swallow. The SLP will look for signs of aspiration, which is when food or drink goes into the larynx (windpipe). An individualized exercise/ treatment plan will be developed to improve the ability to swallow nutrients by the mouth.
Swallow problems may become more obvious during the course of medical treatment. Various treatment options for managing oral, head and neck cancers can result in soreness of the mouth, dry mouth/no saliva, difficulty with moving food with the tongue, chewing problems or pain that causes avoidance of eating. Medical treatment can also result in hoarse voice, loss of voice and stiff mouth. These can occur after reconstructive surgery of part of the mouth or throat.
The SLP will work with the patient to maintain eating/swallowing and communicating abilities that are as independent and functional as possible before, during and after the course of treatment. The goal of therapy is to maintain the best quality of life during the treatment and recuperation process.
Additional information regarding Speech-Language Pathologist and dysphagia management can be found by visiting The American Speech-Language and Hearing Association at www.ASAH.org.
Christine M. Bove, M.A., CCC-SLP
National Spokesperson for HNCA & squamous cell carcinoma survivor