A swallowing disorder, also called dysphagia, means you have problems with eating or drinking. Some people may gag, cough, or choke. Others may feel like food is stuck in their throat.

Our speech pathologists have extensive expertise in evaluating and managing swallowing disorders. A speech pathologist is a trained specialist knowledgeable in helping people use muscles in the mouth and throat.

The first step is a thorough evaluation. After that, our team will make a plan for therapy. Rehabilitation includes exercises to stretch and strengthen the muscles that help you swallow. A speech pathologist may also suggest new strategies or techniques to make it easier for you to swallow as well as recommend modified food textures or consistencies. We may also refer you to other MSK specialists for further evaluation or interventions.

Swallowing disorders can be challenging to manage. One of the most important aspects of our team is its multidisciplinary approach. People with cancer receive personalized care from speech pathologists, surgeons, dentists, radiologists, radiation oncologists, gastroenterologists, and nutritionists.

Here are a few of the procedures our team performs as part of swallow therapy:

• Modified barium swallow exam
  A modified barium swallow exam (also called videofluoroscopy) is a video technology similar to an x-ray. During the exam, you will swallow various consistencies of food, ranging from liquids to solids, that contain a substance called barium, which shows up on an x-ray. By watching the swallowing process on x-ray, our team can identify problems you may be having, test strategies to compensate for them, and make a plan for your care.
• Fiberoptic endoscopic evaluation of swallowing (FEES)
  During a FEES exam, a thin, lighted tube called an endoscope is inserted through your nose and guided into your throat. A camera at the tip of the tube allows the team to evaluate any issues in the throat as you swallow various foods.
• Vocal fold injection augmentation
  When your vocal folds (also known as vocal cords) do not fully come together as they should, either because of thinning or problems with their movement, you may choke when swallowing. Vocal fold injection augmentation is usually performed in the office under local anesthesia. This temporary procedure can help with swallowing. For patients who require a lasting solution, we may perform a surgical procedure that permanently closes the vocal folds. This is called type I thyroplasty or medialization laryngoplasty.
• Esophageal dilation
  Sometimes cancer treatment may cause narrowing of the esophagus or swallowing tube, and swallow therapy alone is not enough to help. These narrowed areas can be dilated or stretched to improve the passage of food. Dilation can be done under sedation or general anesthesia by our surgeons or gastrointestinal specialists.

When treating head and neck cancers, our surgeons and oncologists use specialized techniques and approaches to preserve your speech and communication function as much as possible.

Our speech pathology team will evaluate your speech function before starting treatment, as well as explain what to expect during and after treatment. The team will work closely with you throughout your care to help preserve and improve speech function.

Our speech pathologists can help to manage conditions such as:

• Trismus
  Reduced jaw opening, or trismus, can occur anytime during, right after, or even years after treatment. Trismus can impact how well someone can move their mouth to form words. Our speech pathology team works closely with people to prevent trismus but also uses a variety of tools, such as a TheraBite® (a handheld jaw motion rehabilitation system), exercises, and massage, to treat trismus if it develops.
• Speech and articulation changes
  As a result of treatment, you may develop weakness and lack of coordination in your tongue, lips, cheeks, or other muscles you use to help you form words for speech. The speech pathology team can offer a range of exercises, strategies, and techniques to help you speak more clearly.
• Dental or oral prosthetics
  If you require a prosthetic device as part of reconstruction following surgery for oral cancer, our speech pathologists will work closely with the dental team to help ensure the device is comfortable and meets your needs. They also will provide therapy to complement the use of the prosthetic.

The MSK speech pathology team see patients on an outpatient basis but can also provide evaluations and treatment for people while in the hospital.

You may develop problems with your voice as a result of cancer or its treatment. Surgery or radiation therapy may cause your voice to become hoarse, weak, or completely lost. Other times, the tumor or lesion itself may affect your vocal folds.

MSK’s speech pathology team provides complete voice evaluations, including analyses of vocal fold function and voice production. We also use a technology called laryngeal videostroboscopy that provides a slow-motion view of the vocal folds. This painless, noninvasive procedure uses a strobe light on an endoscope (a thin tube) to capture the series of images that can be studied by an expert.

Voice therapy uses a number of techniques to compensate for an affected vocal fold. This may include exercises, biofeedback techniques, and certain devices to increase and maximize muscle strength in your vocal folds as well as to improve breath support for the voice or decrease vocal strain.

In some cases of benign vocal fold lesions, voice therapy alone may make the lesion go away, allowing you to avoid surgery. Other times, voice therapy plays a key role after surgery to improve healing and prevent lesions from coming back. Many people with cancer also benefit from injections of filler material to bulk up the vocal folds or a surgical procedure called medialization laryngoplasty, which moves the impaired or paralyzed vocal folds to the middle of the larynx (voice box).

Find in-depth information about vocal cord paralysis.

Laryngectomy is surgery to remove the larynx (your voice box). If you have your larynx removed, you will need to learn a new way to produce speech as a part of your recovery.

Our speech pathologists have great expertise in working with people to regain their ability to speak after laryngectomy. They can provide comprehensive rehabilitation before and after surgery, counsel you about your options, and work closely with you and your family throughout the recovery process.

Ways we can help people communicate after laryngectomy include:

• Electrolarynx
  This is a device that allows for an artificial voice. A patient puts the device against the neck and presses a button, which causes sound to come out. By moving the tongue and mouth, the patient can form the sound into words. Many people can use the device within three to five days after surgery, initially using an adaptor for the mouth.
• Esophageal speech
  This is a way of producing speech that does not require the larynx. It involves swallowing air into the esophagus and then pushing it back up through the throat and mouth. Esophageal speech can take up to three to six months of training with a speech therapist to learn.
• Tracheoesophageal (TEP) speech
  This is another way of producing speech that does not require the larynx. In order to enable TEP speech, our surgeons create a small opening between the esophagus and the trachea (your windpipe) and place a small one-way valve there. This procedure is called tracheoesophageal puncture. The valve keeps food out of your windpipe but lets air into the esophagus to allow you to use your voice.

Find more in-depth information about laryngectomy, including ways to communicate.

The Speech and Hearing Center participates in clinical research with the aim of improving the therapeutic options available to people with hearing, swallowing, speech, language, and voice deficits.

Our ongoing areas of research include:

• hearing loss in adult survivors of childhood cancer that was treated with radiation therapy
• hearing loss rates in people who received a certain chemotherapy as part of treatment for osteosarcoma
• hearing loss associated with NF2-related schwannomatosis
• swallow function outcomes after reduced-dose radiation for HPV-related head and neck cancers
• swallow function and patient-reported outcomes in a proactive versus reactive approach to preserving swallow function in patients receiving radiation for head and neck cancers
• outcomes of vocal fold (vocal cord) injection augmentation in patients with vocal fold paralysis due to advanced cancer

Past research studies have included:

• the role of the brain in the rehabilitation of speech and swallowing function
• the use of functional MRI and other MRI techniques in assessing speech and swallow function during head and neck surgery
• the cellular dynamics of wound healing in the upper aerodigestive tract (lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe) and the effects of radiation on speech and swallowing