Speech, voice and swallowing

Surgery or treatment for head and neck cancer may cause changes to your mouth (lips, teeth, tongue, floor of mouth, cheeks, palate) and/or throat (pharynx, larynx), which may affect your ability to speak and/or swallow. These changes may be temporary or lasting and can have an impact on your daily life. A speech pathologist can help you with any difficulties you are having with your swallowing and communication.

SPEECH

Our speech is our ability to produce clear sounds and be understood when talking. Changes to our speech are called ‘dysarthria’. Speech can be affected by the presence of a tumour in the mouth or throat, or by treatment for the tumour such as surgery or radiotherapy to these areas. The effect can vary from mild to severe problems relating to the feeling and movement of your mouth. Changes to your speech may leave you feeling frustrated, isolated or upset, particularly if your friends, family, colleagues or health professionals have trouble understanding you or it effects your ability to return to work.

A Speech Pathologist can help to keep you communicating. Options may include:

  • Writing: e.g. a paper and pen, boogie, writing or white board
  • Smart phones or tablet: e.g. using apps such as ‘Text’, ‘iSpeech’ and ‘Aloud! Text to speech’, ‘Proloquo2Go’.
  • Speech therapy and exercises
  • Side effects management: e.g. saliva substitutes for dry mouth

General speech strategies include:

  • Say one word or phrase at a time
  • Slow down your speech
  • Check that the person you are speaking with understands you
  • Avoid speaking when you are tired
  • Use drawing, pointing or gesture to help get your message across
  • Over pronounce or exaggerate your speech sounds

VOICE

Our voice is the sound produced by the vibration of our vocal cords. Our vocal cords are two bands of tissue in the larynx (throat) at the top of the airway. They protect our airway from food/fluid/saliva, allow us to cough and also produce our voice. Several different types of cancer and cancer treatments can impact the movement of the vocal cords, resulting in a ‘hoarse’, ‘rough’, ‘soft, ‘breathy’ or ‘strained’ voice, known as dysphonia. You may also experience voice changes if you have a breathing tube down your throat during surgery or if you are having radiation treatment to your throat.  

A speech pathologist will work with other members of the medical team to assess the sound of your voice
and the way your vocal cords move, then start therapy or implement strategies to help you. Assessment often involves a fine camera scope passing through your nostril to get a bird’s eye view of your vocal cords. This helps to accurately identify the problem and an individualised therapy plan.

Some general voice care or ‘vocal hygiene’ tips can be found below if you are experiencing dysphonia:

  • Keep hydrated, drink plenty of water (note: if you are having trouble swallowing it is important you see a speech pathologist as soon as possible)
  • Rest your voice where possible, avoid whispering
  • Wherever possible do not strain to produce your voice. Limit background noise and do not yell/shout
  • Limit irritants such as smoke, dust, pollution
  • Avoid continuous throat clearing or coughing – if you have an ongoing cough, please speak to your doctor
  • Stop smoking
  • Some medications can cause voice problems – speak to your doctor or pharmacist about the side effects of the medication you are taking

SWALLOWING

Difficulty swallowing is known as ‘dysphagia’. Dysphagia can be caused by a number of cancers and their
treatment. People with dysphagia may describe coughing or choking while eating or drinking or that food and drink gets stuck. Side effects of chemo or radiotherapy may also cause ulceration or dry mouth, making chewing difficult. Some people will need teeth to be removed, this can change the way they chew.

‘Aspiration’ is when food or drink goes down the wrong way into your airway. This can result in coughing
and sometimes pneumonia.

Signs of dysphagia may include:

  • Coughing or choking when eating or drinking
  • Feeling a need to clear your throat after eating/drinking
  • Your voice sounds wet after eating/drinking
  • You become short of breath during/after eating or drinking
  • Food or drink becoming stuck in your throat
  • Feeling like you need to take multiple swallows to clear food/drink from your throat
  • Discomfort when swallowing
  • Taking you longer to finish a meal than normal
  • Food or drink coming out of your nose
  • Difficulty chewing food

If you are experiencing any of these difficulties it is important to see a speech pathologist. A speech
pathologist can give you recommendations on the safest and most comfortable food/drinks, start swallowing therapy and if required can perform further examinations of your swallowing:

  • Videofluoroscopic Swallow Study (VFSS)– an x-ray of your swallowing
  • Fiberoptic Endoscopic Evaluation of the Swallowing (FEES)– a fine scope is passed through your nose and into your throat so your swallow can be assessed and watched on camera

Some general safe swallow strategies are as follows:

  • Sit upright, as if in a straight backed chair during and after a meal
  • Maintain good mouth care
  • Avoid talking and eating at the same time
  • Check that the inside of your mouth is clear at the end of the meal
  • Small mouthfuls, taken slowly, often with something to moisten hard or dry foods
  • Avoid eating and drinking when tired or drowsy

Where can I find support?

If your treatment has caused changes to your speech, voice or swallowing, you can get help from a speech pathologist. A speech pathologist is an expert in difficulties with communication and swallowing. Your doctor may recommend you see a speech pathologist before, during and after your treatment. You may also get help from a doctor or a dietitian and in some cases they may recommend a feeding tube.