Swallowing Problems (Dysphagia) After Head and Neck Cancer
What are swallowing problems after head and neck cancer?
People who have been treated for head and neck cancer, such as laryngeal cancer or oral cancer, often experience swallowing problems (dysphagia). The seriousness of the swallowing problem depends on the type and nature of the treatment, the size and location of the tumor, and the nature of any reconstruction.
What are some signs or symptoms of swallowing problems after head and neck cancer?
Individuals treated for head and neck cancer may experience any or all of the following swallowing problems:
- the need to swallow many times to clear food from the mouth and throat
- gurgly, wet-sounding voice after swallowing
- coughing or choking
- throat clearing while eating
- pain and dryness when swallowing
How are swallowing problems after head and neck cancer diagnosed?
Speech-language pathologists (SLPs) typically see a person prior to medical or surgical intervention. The SLP will discuss possible changes in speech and swallowing. After the intervention, the SLP will evaluate the individual to determine the nature of any swallowing disorder and the appropriate diet for that person. The person may initially have a feeding tube through his or her nose until swelling from surgery goes down. If the SLP suspects a pharyngeal swallowing problem, additional studies may be recommended to determine the risk of aspiration.
What treatments are available for people with swallowing problems after head and neck cancer?
If the individual requires treatment for swallowing problems, the SLP can work with him or her to improve swallowing function.
Therapy may include:
- muscle exercises
- compensatory strategies
- head postures ( e.g., chin tucks or turning the head to one side may help for a safe swallow)
- designing a safe diet
- safe swallow techniques
What other organizations have information on swallowing problems after head and neck cancer?
This list is not exhaustive and inclusion does not imply endorsement of the organization or the content of the Web site by ASHA.
What causes swallowing problems after head and neck cancer?
Swallowing problems can occur after cancerous sections of the mouth, throat, or larynx (voice box) are surgically removed and after radiation therapy. The following are some surgeries and therapies that affect swallowing:
- Oral (mouth) surgery: can result in loss of food or liquid from front of mouth and loss of overall control of food, including chewing and swallowing
- Pharynx (throat) surgery: can result in difficulty moving food and liquids from the mouth into esophagus and may aspirate food into the lungs
- Laryngectomy: can have difficulty moving food and liquids from the mouth to the esophagus
- Radiation therapy: can lead to soreness in the mouth and throat, reduced salvia, dry mouth, and limited movement of the remaining structures; may be hard to chew and move food from mouth through the throat; throat pain may lead to less eating
How effective are treatments for swallowing problems after head and neck cancer?
ASHA produced a treatment efficacy summary on swallowing disorders [PDF] that describes evidence about how well treatment works. This summary is useful not only to individuals with swallowing disorders and their caregivers but also to insurance companies considering payment for much needed services for swallowing disorders in adults.
What does a speech-language pathologist do when working with individuals with swallowing problems after head and neck cancer?
It is ASHA's position that "speech-language pathologists play a primary role in the evaluation and treatment of infants, children, and adults with swallowing and feeding disorders."
ASHA has developed a number of documents about the role of the SLP working with individuals with swallowing disorders. These include:
The Preferred Practice Patterns for the Profession of Speech-Language Pathology outline the common practices followed by SLPs when engaging in various aspects of the profession. The Preferred Practice Patterns for swallowing and feeding assessment and intervention for children are outlined in Sections 40 and 41, and the adult information is outlined in Sections 42 and 43.