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Head and neck cancer can affect a person's ability to speak and swallow due to the location of the tumour and the treatment used to remove it. The extent of the impact on speech and swallowing will depend on several factors, including the size and location (mouth and throat) of the tumour, the stage of cancer, the type of head and neck cancer treatment used, and the individual's overall health. These changes may be temporary or lasting and can have an impact on a patient's daily life.
Signs and symptoms of speech and swallowing problems
People with difficulty in swallowing (known as 'dysphagia') describe it as coughing or choking while eating or drinking or food getting stuck. Sometimes food or drink goes down the wrong way into the airway, resulting in coughing and sometimes pneumonia; this is called aspiration.
Symptoms of dysphagia may include:
- Coughing or choking while eating or drinking
- taking longer to chew and swallow
- pain or discomfort when swallowing
- Feeling a need to clear your throat after eating/drinking
- You become short of breath during/after eating or drinking
- food sticking in your mouth or throat
- Feeling like you need to take multiple swallows to clear food/drink from your throat
- Food or drink coming out of your nose
Speech and swallowing problems can occur due to head and neck cancer and its treatment. You may have difficulty making certain sounds or saying some words. Thick, sticky saliva may make it difficult for you to speak. Reduced saliva causes a dry mouth. This can also make your mouth and throat feel uncomfortable during long conversations.
Voice is the sound produced by the vibration of the vocal cords in the voice box (larynx). Several cancer types and head and neck cancer treatments can affect the movement of the vocal cords and your voice. This can result in 'hoarse', 'rough', 'soft', 'breathy' or 'strained' voices, known as dysphonia.
Treatment Options for Head and Neck Cancers
Head and neck cancer treatment options include head and neck cancer chemotherapy, radiation therapy and head and neck surgery. Depending on the type of cancer, its location and the treatment, speech and swallowing problems can occur.
Radiation therapy
Based on the tumour size and location, radiation therapy for head and neck cancers cause inflammation and scarring of the muscles and structures that help you swallow and keep them from working as well as they did before. This can make it hard to eat and drink normally.
Radiation therapy can cause:
- dry mouth
- sores in mouth and throat
- thick saliva secretion
- swelling
- changes in taste
Usually, these head and neck cancer symptoms appear 1 to 2 weeks after initiating radiation therapy. The symptoms may worsen during the treatment. Most of these head and neck cancer symptoms will get better 2 to 4 weeks after finishing the treatment.
Radiation therapy can also cause permanent tissue scarring; some of its effects are listed below.
- The tightening of the muscles attached to your jaw makes it hard to open your mouth and chew your food (trismus).
- Reduced secretion of saliva by the salivary glands, making your mouth dry and causing difficulty in swallowing and dental problems (tooth decay & gum disease)
- Decreased movement of the muscles in your tongue and the back of your throat, making it harder to speak and to push food or liquids down your throat and open up your oesophagus (the tube that connects the throat to the stomach).
- Weakening of the muscles that help protect your airway when you swallow, which may not be able to prevent the foods or liquids from going down your airway.
- Narrowing of the oesophagus, which can cause the food to get stuck in the back of your throat.
- difficulty in taking hot and spicy food
Not everyone undergoing radiation for head and neck cancer will have all these problems. Your healthcare team will plan the treatment to lower the chances of such problems and, if they occur, help you manage them.
Surgery
Head and neck surgery to remove the tumour may result in scarring and changes in the anatomy of the mouth and throat that can make it difficult to speak or swallow. Some cancers in the mouth, throat, or larynx are treated by surgery. Radiation therapy may be required before or after surgery. Different types of surgeries may lead to signs of swallowing disorders.
Oral surgery: This surgery may involve the removal of part of the tongue. It can cause food or drinks to spill out of your mouth. It may be hard to control food and liquid in your mouth. You may also have trouble chewing.
Throat surgery: It can make it hard for food and liquid to move from your mouth to your oesophagus (the tube that connects the throat to the stomach). After surgery, food or fluids may enter your airway instead of into your oesophagus (aspiration) and result in coughing or choking or pneumonia.
Laryngectomy is a type of throat surgery where all or some part of the voice box is removed. Thus, it makes it hard to speak clearly, or you may find your voice has changed. Even after the removal of the entire larynx, the patients can communicate using the electrolarynx or speaking valve.
Treatment for swallowing and speech problems associated with head and neck cancers A speech pathologist and swallowing therapist can help you to communicate clearly and change your chewing and swallowing actions to reduce discomfort.
The therapist will first assess the changes in the speech, voice and swallowing. He/she will teach you some exercises to use your voice in the best way and take care of your throat.
They can help you to:
- make your voice heard without straining
- increase how long you can easily talk for
- use your muscles to chew and swallow
- sit in the right posture and hold your head when you eat or drink.
Given below are some tips for dysphonia:
- Drink plenty of water to stay hydrated
- Rest your voice whenever possible, and avoid whispering
- Do not strain to produce your voice
- Do not yell or shout
- Limit irritants such as smoke, dust, and pollution
- Avoid continuous throat-clearing or
- Stop smoking
Some tips for swallowing safely:
- Sit upright, like a straight-backed chair, during and after a meal
- Avoid talking and eating at the same time
- Maintain good oral hygiene
- Clean your mouth at the end of every meal
- Take small bites of food along with something to moisten hard or dry foods
- Avoid eating and drinking when tired or drowsy
Conclusion
You can always ask your doctor to recommend medicines that relieve discomfort when swallowing. Consult a speech & swallowing therapist about ways to adjust the consistency of food to make it easier to swallow. A dietitian can make sure you are getting enough nutritious food and drink.
Dr. C. Rayappa Senior Consultant – Head & Neck Oncology and Skull Base Surgery Apollo Cancer Centre, Chennai
