Certain cancer treatments, such as surgery and radiation therapy, may affect a patient's ability to swallow, speak, or hear. While these side effects are most common for patients with head and neck cancers, people with other types of cancer may also experience these functional problems following treatment.
For adult and pediatric patients coping with such issues, Memorial Sloan-Kettering Cancer Center's Speech, Hearing, and Rehabilitation Program provides a variety of services to help restore function and enhance quality of life.
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.
The audiology team provides comprehensive, state-of-the-art hearing services to children and adults. Our primary goal is to work with the medical staff to minimize hearing loss associated with cancer and its treatment.
A hearing evaluation usually involves several different tests, including an assessment of a person's ability to hear quiet sounds presented at different pitches as well as a test of the nerve responsible for hearing. Another test used determines the softest level at which a person can identify words and how well patients can recognize words that are similar. We also assess how well the ear drum moves and learn more about the overall function of the middle ear through an examination called tympanometry. Finally, a test of otoacoustic emissions is performed to monitor high-pitch hearing loss associated with some cancer treatments and medications.
The Program also provides instruments such as amplified telephones and teletypewriters (TTYs) for people with hearing loss.
In addition to our focus on clinical care, the Speech, Hearing, and Rehabilitation Program also conducts research in hopes of improving the way we evaluate and treat patients with hearing, swallowing, speech, language, and voice deficits.
One of our major research initiatives is to determine the role of the brain in the rehabilitation of speech and swallowing function. We are currently using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to assess a person's ability to speak and swallow during head and neck surgery. These imaging technologies produce “brain maps” that show areas of the brain associated with speech and swallowing — these locations in the brain can vary from one person to the next. Brain maps of patients with cancer are then compared to maps of healthy people, as well as to patients before and after treatment. This research provides valuable insight into the sensorimotor organization of the brain, helps us to better understand brain plasticity, and may provide novel rehabilitation strategies for speech and swallowing deficits.
The research staff also has an active program investigating the cellular dynamics of wound healing in the upper aerodigestive tract (which includes the lips, mouth, tongue, nose, throat, vocal cords, and part of the esophagus and windpipe) and the effects of radiation on the structures of speech and swallowing. The goal of this research program is to gain further insight into the underlying mechanisms associated with speech, voice, and swallowing problems in order to develop new therapies for rehabilitation.
The Speech, Hearing, and Rehabilitation Program has many other ongoing research projects including the measurement of quality of life in patients undergoing cancer treatment, the effectiveness of neuromuscular stimulation for swallowing disorders, and the role of tongue strength in swallowing function.
The Speech, Hearing, and Rehabilitation Program at Memorial Sloan-Kettering is composed of a multidisciplinary team of experts who work together to diagnose and treat each patient who comes to the clinic.
Amy Budnick, Audiology
Cindy Ganz, Speech Pathology
Margaret L. Ho, Speech Pathology
Making an Appointment
To make an appointment or to learn more about the Speech, Hearing, and Rehabilitation Center, please contact us at 212-639-5856. Appointments are available Monday through Friday, 9:00 AM to 5:00 PM. All patients, regardless of where they were treated, may make an appointment with one of our specialists.
Speech, Hearing, and Rehabilitation Center
H-120, Howard Building
1275 York Avenue
Between 67th and 68th Street