Speech Pathology
Memorial Sloan-Kettering's speech pathology team offers comprehensive evaluation and treatment for all swallowing, speech, language, and voice deficits. Our specialists have considerable expertise in the management of swallowing disorders (also called dysphagia). A multidisciplinary approach -- incorporating surgeons, dentists, radiologists, gastroenterologists, speech pathologists, and nutritionists -- is employed to help patients manage these challenging conditions.
A variety of tests are used to evaluate swallowing disorders in patients, all of which can help guide the team in developing a treatment plan. For one test, called modified barium swallow or videofluoroscopy, a video technology similar to an x-ray is used to view patients swallowing various consistencies of food ranging from liquids to solids that contain a contrast called barium. By watching the swallowing process on an x-ray, the team can identify and localize any potential deficits.
Another test used at Memorial Sloan-Kettering is called fiberoptic endoscopic evaluation of swallowing (FEES). During FEES, a thin, lighted tube, called an endoscope, is inserted through the nose and guided into the throat, and a camera at the end of the tube enables the team to see inside the throat. With the camera in place, patients swallow various foods while the team views the internal structures associated with swallowing.
Changes in voice are not uncommon in patients with cancer. The speech pathology team conducts comprehensive voice evaluations, including laryngeal videostroboscopy as well as analyses of vocal cord function and voice production. Laryngeal videostroboscopy involves innovative technology to provide a slow-motion view of the vocal cords in motion. This type of assessment is critical to the diagnosis of many conditions affecting the voice.
Following evaluation for all conditions, comprehensive treatment plans are designed to maximize functional outcomes. We offer comprehensive swallowing rehabilitation, including neuromuscular electrical stimulation as well as other treatment options for patients with speech, language, and cognitive disorders.
Our speech pathologists also have particular expertise in alaryngeal speech restoration following the surgical removal of the larynx, or laryngectomy. All patients are seen by our team of speech pathologists prior to surgery for counseling and discussion of the options for rehabilitation. Most patients undergo a procedure called tracheoesophageal puncture, or TEP, during which the surgeon creates a small opening between the esophagus and the trachea. This one-way valve keeps food out of the trachea but lets air into the esophagus to allow voicing.
The Speech, Hearing, and Rehabilitation Program also offers an innovative procedure known as vocal fold augmentation in order to rehabilitate voice and swallowing following damage to the nerves that control the voice box. This procedure is performed under local anesthesia and has been shown to offer immediate improvement in both speech and swallowing for many patients. Alternatively, some patients may require a surgical procedure known as thyroplasty to correct these deficits.
