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Speech Therapy’s Role in Head
and Neck Cancer
Presented By: Jodi Peabody, MS CCC-SLP
Date: 09/09/2016
Screenings

Patient questionnaire provided to all patients
upon initial clinic visit.

Education and information concerning potential
difficulties with speech and or swallowing
provided to patients flagged by questionnaire.

Appropriate evaluation/ treatment provided and
or scheduled as needed.
• May result in outpatient VFSS or outpatient speech therapy
treatment
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Benefits of Screening

Providing education regarding immediate needs, if any. As well as attempting to
minimize latent effects of treatment and maximize function.

Immediate effect post-surgery
• Tolerance for oral intake
• Pain
• Changes in structure
• Aspiration
• Fistualas

Latent Effects can be equally as devastating, and often appear years after
treatment.
• Dysphagia that may appear years after treatment
• Vocal changes
• Reduced muscle range of motion/Stiffness
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Oral Dysphagia
• Trismus• Reduced oral opening.
• Anterior spillage• Spilling of food or liquid out of oral cavity. (drooling)
• Mastication• May be limited secondary to dentition or surgical changes to oral structures.
• Xerostomia• Dry mouth/lack of saliva. Makes initiation of swallow difficult.
• Bolus control• Reduced lingual or labial function may result in poor containment or transport of
bolus.
• Premature spillage into the pharynx• Bolus spills over the base of the tongue prior to initiation of swallow.
• Nasal regurgitation• Poor closure of nasal pharyngeal port.
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Pharyngeal Phase
• Poor laryngeal elevation
–
• decreased pharyngeal propulsion of bolus.
• Decreased epiglottal inversion• increased risk for aspiration.
• Aspiration• Increased risk for recurrent pneumonia.
• Decreased motility• results in pharyngeal residue.
• Decreased cricopharyngeal opening• poor propulsion may not drive opening of cricopharyngus resulting in pharyngeal residue.
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Esophageal Phase
• Solid dysphagia/ Dysmotility- Patient may
report feeling of “food sticking”
• may benefit from esophogram vs. VFSS.
• Strictures- would require probable EGD.
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Trismus
Preventative Education
Home Exercises
Devices- Jaw Dynasplint, tongue depressors
Continual screening- requires ongoing
monitoring as it is easier to prevent than treat.
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Xerostomia
Dry mouth secondary to reduced or absent saliva
flow.
Can be secondary to chemo/ radiation or
medications.
Symptoms: taste disorders, painful tongue,
increased need to drink water, decreased ability to
initiate swallow, chapped lips, & oral candidiasis.
Commercial Products Available:
• Mouth sprays
• Lozenges
• Gels
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Nutrition
Appetite and Taste• often diminished as side effect of cancer treatment.
Oral Feeding• modified diets, calorie counts, pleasure feedings.
Tube Feeding –
• Dobhoff vs. PEG/J-tube, may be used in conjunction with oral feeding.
Supplements• shakes, vitamins, protein bars/drinks.
Coordinate with nutritionist
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Impact of Head and Neck
Cancer on
Communication
Dysarthria secondary to structural
change or nerve involvement.
Voice changes
Language or cognitive difficulties related
to head and neck cancer or cancer
treatment.
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Resources
Support for People with Oral and Head and Neck Cancer
• http://www.spohnc.org/index.php
National Foundation of Swallowing Disorders
• http://swallowingdisorderfoundation.com/
CancerCare
• http://www.cancercare.org/diagnosis/head_and_neck_cancer
National Cancer Institute
• http://www.cancer.gov/types/head-and-neck
Trismus information
• http://oralcancerfoundation.org/complications/trismus.php
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