The Speech Pathology Service at Fox Chase Cancer Center
What is Dysphagia?
Dysphagia is when a person is having difficulty swallowing. Some examples of symptoms of dysphagia: difficulty moving food from the mouth to the throat, difficulty chewing, frequent coughing when eating, slow eating or difficulty consuming normal sized meals, foods sticking in throat, choking or near choking, and/or regurgitation. Dysphagia can lead to weight loss and even pneumonia and should be evaluated promptly. Dysphagia is often a side effect of most types of head and neck cancer treatments.
What is Trismus?
Trismus is when a person is unable to fully open their mouth. Surgery to certain parts of the mouth and/or radiation to the head and neck can lead to trismus. This type of dysfunction can get worse with time and therapy is important to prevent complications.
What is Dysphonia?
Dysphonia describes a change in voice quality that is abnormal such as hoarseness, strain, or breathiness. This type of dysfunction can occur as a result of surgery or radiation to the voice box, neck or chest (sometimes used to treat thyroid cancer, larynx cancer or lung cancer).
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The International Association of Laryngectomees
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Laryngectomy Patients Speak About Their Procedures
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Our Speech Pathology Department offers advanced diagnostic and therapeutic interventions related to vocal pathologies, voice rehabilitation, oral motor and speech dysfunctions, trismus (reduced mouth opening) and dysphagia (difficulty swallowing), performed by Speech Pathologists with specialized training in head and neck cancer rehabilitation.
Our Head and Neck Cancer program at FCCC is interdisciplinary and values input from the Speech Pathology Team to inform medical treatments/surgical interventions for optimal functional outcomes and enhance quality of life during and after treatment.
If you have a diagnosis of head and neck cancer, you can expect to see a Speech Pathologist prior to initiating your treatment, during and/or after your treatment as well. The therapist will evaluate your current level of speech and swallowing function, educate you about changes you may experience to these functions during and after treatment, and design a personalized rehabilitation plan for you to maximize functional outcomes.
Patients who must undergo a total laryngectomy require surgical removal of the voice box and can no longer produce voice (total aphonia). The Speech Pathologist works together with the patient and their surgeon to determine the most appropriate voice restoration method for each patient. Our center offers the latest voice restoration techniques including management of tracheoesophageal puncture (TEP) prosthesis. We also provide expert training for effective utilization of an artificial larynx and for proficient acquisition of esophageal speech.
Services and Therapies
Listed below are the various services this department offers. All services are performed by a licensed, certified speech pathologist with specialized training:
Clinical Evaluation: The clinical evaluation includes a careful review of the patient's medical history, an exam of the muscles and structures of the mouth and throat, assessment of speech quality, and assessment of swallowing function. This may include administration of food and liquid with clinician observation of signs and symptoms of swallowing difficulty during the act of eating and drinking. The clinician will review findings with the patient and together they will develop treatment goals. Based on the results of the clinical exam, the speech pathologist may recommend a more specific test (listed below).
- Video Fluoroscopic Swallowing Study: A video fluoroscopic swallow study (also known as a modified barium swallow study) is a radiologic procedure that evaluates swallowing using a device called a fluoroscope. During this examination, the individual will be asked to swallow a variety of liquids and foods of various textures. A Speech Pathologist performs the test in conjunction with a Radiologist for a thorough assessment of anatomical as well as functional abnormalities. Areas of dysfunction, if present, will be identified as will any aspiration of food or liquid into the lungs. Strategies will be employed to eliminate aspiration during the test, and the findings will assist in treatment planning.
- Fiberoptic Endoscopic Evaluation Of Swallowing: During the fiberoptic swallowing evaluation, a small flexible endoscope is passed through the nose to assess swallowing. The structures within the throat can be seen from a different view, which offer additional information about the swallowing process. This evaluation also provides information that can be useful in preventing complications to health as a result of chronic aspiration and informs treatment planning.
- Voice Evaluation: The voice evaluation includes a careful review of the patient’s medical history, an exam of the muscles and structures of the mouth and throat, manual assessment of extra-laryngeal muscular hyperfunction, perceptual assessments of voice quality, and acoustic measurement of vocal function including a multi-dimensional voice profile. Stroboscopy may also be indicated and performed on this day or at a later date as well. The clinician will review findings with the patient and together they will develop treatment goals.
- Digital Video Stroboscopy: A type of laryngoscopy using either a rigid or flexible scope that allows for more detailed examination of the larynx, including vibratory behavior of the vocal folds. The laryngoscope is connected to a camera with a magnified lens, giving a close up view of the larynx and vocal folds. A strobe (or pulsing) light is used in conjunction with the camera to allow for better evaluation of vocal fold movement. Since the vocal folds move too rapidly for the naked eye to see, the strobe light slows the image of the vibrating folds and allows for more detailed interpretation.
- Air Insufflation Test: This is a test utilized to determine whether a patient is able to achieve voice when air pressure stimulates a segment of the pharyngoesophagus following a total laryngectomy. A small catheter is attached to the stoma and then inserted thru the patient’s nose into the pharyngoesophagus. Air is introduced into the pharyngoesophagus when the patient occludes their stoma and exhales and vibration of the pharyngoesophageal segment should occur. This test is sometimes also performed under fluoroscopy in order to determine why voice is unable to be generated, and informs treatment planning.
Swallowing therapy may include physiotherapeutic exercise to strengthen the swallowing musculature, modification of diet textures and instruction in strategies and maneuvers to compensate for the swallowing problem, and active and passive stretching of musculature affected by radiotherapeutic fibrosis. The therapist coordinates efforts with the physician, dentist, nurse, dietician, occupational therapist, physical therapist nutrition support specialist and any others involved in the care of the patient. In some cases, treatment of a swallowing disorder requires direct medical or surgical intervention by a physician.
Speech therapy may include physiotherapeutic exercise to strengthen muscles within the oral cavity, passive and active stretching of intraoral scar tissue, training with techniques to improve speech intelligibility, and exercises/drills to improve articulation clarity. It can also include training with alternate communication methods such as an Artificial Larynx, Esophageal Speech, and/or TEP speech.
Many causes of hoarseness can be treated through voice therapy, a form of physical therapy for the voice. Conducted by a licensed, certified speech pathologist with special interest and expertise in the treatment of voice disorders, treatment may include exercises for strengthening vocal musculature and improving how one uses their voice for optimal results.
For more information about head and neck cancer treatment and rehabilitation at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427).