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Learn about our Speech-Language Pathology Program

Why Would I Need Speech-Language Pathology Services?

If you have recently been diagnosed with head and neck cancer, you may need to undergo speech or swallowing therapy as part of your rehabilitation treatment. This intervention usually starts at the onset of diagnosis and will continue throughout treatment, and sometimes after that. The amount of difficulty with swallowing or communicating can result from different factors, such as:

  • The location and size of the tumor.
  • The extent of surgery and side effects of treatment.
  • Having prior treatment for head and neck cancer, with or without chemoradiotherapy/radiation.
  • Other factors:  advanced age and other medical conditions (i.e. stroke, neurological disease, COPD), and tracheostomy.

Swallowing Difficulties

Although many consider it a simple action that requires little thought, swallowing is a very complex process. It involves at least 6 cranial nerves and over 20 muscles of the mouth, throat, and esophagus (food tube). They all work together to coordinate the movements needed to transport a bite of food or sip of water from the mouth, through the throat, and to the stomach.

Difficulty swallowing, also known as dysphagia, is common in patients who are diagnosed with head and neck cancer.  If left untreated, it can cause dehydration, weight loss, and aspiration pneumonia, which can be life-threatening.

Treatment of head and neck cancer can change how food is transferred.  Eating may require more time and effort and certain textures are sometimes difficult to swallow.  An evaluation will assess swallowing “safety” (if food and/or liquid enters the airway) and “efficiency” (how easily the food and liquid can be swallowed).

Symptoms of dysphagia:

  • Coughing or choking.
  • The sensation of food sticking in the throat.
  • Pain with swallowing, also known as odynophagia.
  • Developing a wet gurgly vocal quality after eating or drinking.
  • Food or liquid coming back up from the esophagus (food tube) or out of the nose.
  • Taking a longer time to eat.
  • Weight loss.
  • Recurrent aspiration pneumonias.

Communication Difficulties

Tumor location and the extent of treatment and its side effects can cause changes with communication (speech and voicing).  Some of the changes may be temporary, while others are permanent. 

Following surgical treatment:

  • The ability to pronounce words clearly is impaired if the surgery involves the lips, tongue, or jaw. The changes can be due to swelling and pain immediately following surgery and often improve as the symptoms decrease.  If the surgery is extensive (removes 50% or more of certain structures), speech may be difficult to understand.
  • If surgery involves the larynx (voice box), a partial laryngectomy may cause the voice to sound breathy or hoarse. A total laryngectomy, or complete removal of the voice box, results in no voice (aphonia).

Following radiation therapy or chemoradiotherapy:

  • Radiation side effects cause scarring of the tissues (fibrosis) and can worsen over time.  This leads to limited movement of the structures related to speech and swallowing.  If the voice box is radiated, the quality of the voice may sound hoarse.
  • Chemotherapy increases the side effects of radiation.

How Can a Speech-Language Pathologist Help?

A speech-language pathologist (SLP) is part of the cancer care team and specializes in managing the communication and swallowing disorders associated with the disease. An SLP will evaluate a patient's current speech and swallowing function, provide education on potential changes, and develop a therapy plan. 

Swallowing Therapy

Swallowing therapy begins after the evaluation and the goals and plans are developed with the patient.   Swallowing therapy may include swallowing strategies (i.e. head rotations, breath hold techniques to protect the airway, different delivery methods to transfer food, and diet textures changes) to improve safety and efficiency when eating and drinking.  Swallowing exercises target specific muscles to improve strength and range of motion.  Patients often benefit from a combination of strategies and exercise to obtain the best results.

The goal of swallowing therapy is to improve quality of life by helping patients safely maintain an oral diet.  Studies have shown that early intervention results in better outcomes and reduces the need for feeding tube dependency.

Speech Therapy

An SLP will provide techniques on how to improve speech so it is better understood by others.  

Techniques may include:

  • Slowing the rate of speech.
  • Over exaggerating the word pronounced.
  • Increasing volume.
  • Minimizing background noise.

Range of motion exercises are often used to help facilitate better movement of the tongue, lips, and jaw.  If structures are increasingly stiff from radiation treatment, myofascial release, a form of deep tissue massage, may benefit the patient.  At UPMC, myofascial release is offered by a physical therapist (PT) who specializes in treatment of the head and neck.  The combined approach of having an SLP and PT co-treat is invaluable.

Voice Therapy

A total laryngectomy is the surgical removal of the voice box.  An SLP can introduce the different forms of communication that can be used, such as esophageal speech, electrolaryngeal speech, communication devices (AAC), and tracheoesophageal (TE) voicing. 

If a patient has a tracheoesophageal puncture, a voice prosthesis can be placed by an SLP.  The SLP will train the patient on how to use and care for the device.  Because these devices wear out over time, they need to be replaced by a trained SLP.  To learn more about laryngectomy care, please review the services provided by SLPs in the Department of Otolaryngology.

Key Things to Remember About Speech-Language Pathology Intervention

  • Changes with communication and swallowing are not the same for every patient.  The extent of difficulty will depend on the size/ location of tumor and treatment.  Pre-operative counseling with a speech-language pathologist is the first step in understanding what to expect and how to prepare for treatment. The speech-language pathologists in the Department of Otolaryngology evaluate, treat, educate, and provide support throughout your journey of cancer.  Ask your doctor for a referral.  For more information contact….
  • If the choice of treatment is radiation, early intervention for swallowing therapy has shown better outcomes.  It is recommended to start swallowing exercises before the onset of treatment and to continue for life to help maintain muscle function and strength. Patients who have started to receive radiation treatment or who have received radiation in the past can be evaluated by a multidisciplinary team in the UPMC Survivorship Clinic.  Learn more about the UPMC Survivorship Clinic.

Reach out to your doctor to learn more about treatment options and resources.