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Get Help for Speech and Swallowing Difficulties after Head and Neck Cancer

by Mary J. Bacon, MA, CCC-SLP, BCS-S

A diagnosis of head and neck can­cer often raises concerns about speech clarity, voice quality, and swallowing ability. The degree to which a person’s speech and swallowing func­tions are affected varies depending on the type, size, and location of the tumor and the method used to treat it. Some people glide through treatment with little difficulty, while others experience impairment that is more extensive.

What Are the Potential Complica­tions?
Base-of-tongue and throat (pharynx) tumors can hinder swallow­ing. Cancer of the voice box (larynx) has the potential to instigate voice changes as well as swallowing issues. Surgical removal of the larynx (laryngectomy) is sometimes necessary and requires voice restoration therapy afterward. Surgery involving the lips or tongue can cause changes in articulation and can affect the oral stage of swallowing. Nasal re­gurgitation when eating or drinking is a concern after treatment for tumors on the roof of the mouth, as are changes in nasal resonance during speech.

Non-surgical treatments can also cause problems. Radiation therapy directed at the head and neck area can produce both short-term and long-term changes in speech and swallowing function. The effects of chemotherapy on speech and swallowing tend to be short term; nonetheless, these changes deserve attention during cancer treat­ment as well.

What Can You Do about Them?
Regardless of your level of impairment, a speech pathologist can be tremen­dously helpful in managing the side effects of head and neck cancer and its treatment.

Difficulty Swallowing If you’re having difficulty moving food and liq­uid through your mouth to your throat, a speech pathologist will need to ob­serve the swallowing process. This is done by viewing a moving-picture X-ray (videofluoroscopy) or by introducing a small flexible telescope through your nose, allowing a view of the swallow­ing process from above.

Author of Article photo

Mary Bacon

After the swallowing evaluation, the speech pathologist can recommend strategies to help you swallow food and liquids so that they go down the right way or exercises to maximize the strength and range of motion of your swallowing structures.

Other professionals can help too. For instance, dietitians can give you advice on how to get the nutrition you need when swallowing is difficult. Dentists can help you maintain good oral hygiene, which is important when a threat of aspiration (food or liquid going into the airway) exists. If dry mouth is making swallowing difficult, you can turn to your speech pathologist, dentist, or nurse, each of whom can provide sug­gestions for relief.

Speech and Voice Quality Treatment directed toward your tongue or lips can affect speech clarity. A speech patholo­gist can suggest strategies to help you speak more clearly or provide therapy to help you improve specific sounds that you may be struggling with. In rare situ­ations, you may have to consider using an alternative communication mecha­nism, such as a computer-generated speech device.

If your soft or hard palate (roof of the mouth) has been affected, your speech pathologist may need to enlist the assistance of a specialized dentist who can fashion a prosthesis to separate the oral and nasal cavities.

If you have a laryngeal tumor, your voice, as well as your swallowing func­tion, may be compromised. If you do experience voice changes, your speech pathologist can offer therapy to help you maintain functional voice quality. If total laryngectomy is required, your speech pathologist will offer training with an artificial larynx device (often called an electrolarynx), esophageal speech, or tracheo-esophageal speech.

Knowing that speech, voice, and swallowing problems can result from head and neck can­cer, you should schedule a visit with a speech pathologist before beginning treat­ment if possible. Your speech path- ologist, along with the other members of your healthcare team, will work with you to help to ensure your best possible treatment outcome.

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Mary J. Bacon is associate professor emerita of communication disorders and sciences at Rush University in Chicago, IL. With more than 30 years of experience working with head and neck cancer survivors, she holds the Certificate of Clinical Competence from the American Speech-Language Hearing Association and is board certified in swal­lowing and swallowing disorders.

For more information on coping with head and neck cancer, Mary recommends visiting,,, and

This article was published in Coping® with Cancer magazine, March/April 2015.