Speech
Reduced overall intelligibility resulting from one or all of the following:
- Articulation errors (e.g., omissions, substitutions, and distortions of stops, fricatives, and affricates; vowel errors)
- Imprecise speech (e.g., due to dysarthria from cranial nerve palsies)
- Distortions of lingual phonemes consistent with lingual resection and/or reconstruction
Voice
- Dysphonia (e.g., changes in vocal pitch, loudness, and/or quality) resulting from untreated tumors within the larynx or supraglottic larynx, surgical resection of the larynx, and/or radiation
- Aphonia (i.e., loss of voice) postsurgery (e.g., with tracheostomy tube or total laryngectomy)
See ASHA's Practice Portal page on
Voice Disorders for more details related to signs and symptoms of dysphonia.
Resonance
- Hypernasality (e.g., surgical resection to the soft palate, immobility as a result of radiation sequelae and/or a soft-palate defect)
- Hyponasality (e.g., due to obstruction in nasal passage)
- Cul-de-sac resonance (associated with base of tongue lesions)
See
Classification of Velopharyngeal Dysfunction.
Swallowing
Severity of swallowing problems in HNC depends on tumor size and location, staging, and treatment protocol (e.g., surgical resection and reconstruction, radiation therapy, chemotherapy).
Total laryngectomy surgery typically does not result in swallowing disorders. However, they occasionally occur due to scar tissue at the tongue base, reduced tongue base posterior motion, stricture or narrowing of the esophagus, and poor bolus clearance through the pharynx if a portion of the tongue base is included in the resection.
Functional signs and symptoms of swallowing problems include the following:
Changes in structural integrity and changes in sensation, strength, range of motion, and coordination of orofacial musculature may result in one or more of the following:
- Oral phase dysphagia:
- Increased oral transit time
- Impaired bolus manipulation
- Increased oral residue
- Impaired mastication
- Premature spillage
- Anterior bolus loss
- Pharyngeal phase dysphagia:
- Delayed triggering of pharyngeal swallow
- Velar leak resulting in movement of materials into the nasopharynx
- Impaired tongue base movement
- Reduced pharyngeal contraction
- Decreased laryngeal and hyoid elevation and anterior motion
- Reduced epiglottic closure, resulting in increased risk for aspiration
- Reduced glottic closure
- Reduced upper esophageal opening
- Aspiration
- Residue in valleculae and pyriform sinuses
See ASHA's Practice Portal page on
Adult Dysphagia for more details related to signs and symptoms of swallowing disorders.
Hearing
- Changes in hearing acuity (e.g., as a result of surgery, radiation, or ototoxicity from chemotherapy)
- Tinnitus
See, for example, Dell'Aringa et al. (2009).
See also ASHA's Practice Portal pages on
Hearing Loss Beyond Early Childhood and
Tinnitus and Hyperacusis.