Certain cancer treatments, such as surgery, chemotherapy, and radiation therapy, may affect a person’s ability to swallow, speak, or hear. These side effects are most common among those treated for head and neck cancers, but people with other types of cancer may experience them.
Memorial Sloan Kettering’s Speech and Hearing Center provides a variety of services to help people overcome speech and hearing problems following cancer treatment.
Our team has extensive training and experience in swallow therapy, voice therapy, and hearing therapy for people of all ages. Furthermore, we have access to the latest technological advances, allowing us to offer highly precise evaluations and innovative therapeutic options.
Our speech and hearing specialists offer appointments on an outpatient basis and are available to work with MSK patients during their hospital stay.
Help for Speech and Swallowing Problems
Our highly experienced speech pathologists have particular expertise in the following therapies:
A swallowing disorder, also called dysphagia, means you have problems with eating or drinking. Some people may gag, cough, or choke. Others may feel like food is stuck in their throat.
Our speech pathologists have considerable expertise in the management of swallowing disorders. A speech pathologist is a trained specialist knowledgeable in helping people use muscles in the mouth and throat.
The first step is a thorough evaluation. After that, our team makes a plan for therapy. Rehabilitation includes exercises to stretch and strengthen the muscles involved in swallowing.
These can be challenging conditions to manage. One of the most important aspects of our team is its multidisciplinary approach. Patients receive personalized care from speech pathologists, surgeons, dentists, radiologists, radiation oncologists, gastroenterologists, and nutritionists.
Here are a few of the procedures our team performs as part of swallow therapy:
- Modified barium swallow exam
A modified barium swallow exam (also called videofluoroscopy) is a video technology similar to an x-ray. During the exam, the patient swallows various consistencies of food ranging from liquids to solids that contain a substance called barium, which shows up on the x-ray. By watching the swallowing process on an x-ray, the team can identify problems and make a plan for care.
- Fiberoptic endoscopic evaluation of swallowing (FEES)
During FEES, a thin, lighted tube, called an endoscope, is inserted through the patient’s nose and guided into the throat. A camera at the tip of the tube allows the team to evaluate any issues in the throat as the patient swallows various foods.
- Vocal fold augmentation
This innovative procedure can be used to rehabilitate damaged nerves that control the voice box. It is performed under local anesthesia and has been shown to offer immediate improvement in voice and sometimes swallow function for many people. Alternatively, some patients may require a surgical procedure known as thyroplasty to correct these deficits.
Sometimes people develop problems with their voice as a result of cancer or its treatment. Surgery or radiation therapy may cause the voice to become hoarse, weak, or completely lost. Other times, the tumor itself may affect the vocal cords.
MSK’s speech pathology team provides complete voice evaluations, including analyses of vocal cord function and voice production. We also use laryngeal videostroboscopy, an innovative technology that provides a slow-motion view of the vocal cords.
Voice therapy uses exercises to strengthen the vocal cords as well as other approaches to compensate for an affected vocal cord. Our rehabilitation plans may include exercises, biofeedback techniques, and devices to increase and maximize muscle strength in your vocal cords, as well as improve breath support for the voice. Many patients can also benefit from vocal fold augmentation to repair damaged nerves.
Speech Restoration after Laryngectomy
Laryngectomy is a surgery to remove the larynx (voice box). As part of their recovery, people who have their larynx removed will need to learn a new way to produce speech.
Our speech pathologists have particular expertise in working with people to regain their ability to speak after laryngectomy. They provide comprehensive rehabilitation to patients before and after surgery, counseling them about their options and working closely with them and their families throughout the recovery process.
Ways we can help people communicate after laryngectomy include:
This is a device that allows for artificial voicing. You put the device against your neck and form words with your mouth to produce voice. Many people are able to use the device within three to five days after surgery, using an adaptor for the mouth initially.
- Esophageal speech
This is an alternative way of producing speech that doesn’t require the larynx. It involves swallowing air into the esophagus and then pushing it back up through the throat and mouth. Esophageal speech can take up to three to six months of training with a speech therapist to learn.
- Tracheoesophegeal (TEP) speech
This is another way of producing speech that doesn’t require the larynx. In order to allow TEP speech, MSK head and neck surgeons must create a small opening between the esophagus and the trachea and place a small one-way valve there. This procedure is called tracheoesophageal puncture. The valve keeps food out of the trachea but lets air into the esophagus to allow people to use their voice.
Help for Hearing Loss
Hearing loss is a common side effect of cancer treatment. Most frequently it occurs when toxicity from chemotherapy or radiation causes injury to the inner ear. This is also called ototoxicity.
The audiology team provides diagnostic and therapeutic approaches for the detection and management of hearing loss resulting from ototoxicity
We use a variety of tests to diagnose hearing problems. These include:
- pure tone audiometry, which provides a baseline measure of hearing levels
- speech audiometry, which determines how softly you are able to hear words and how clearly you are able to understand words
- tympanometry, which tests how well the middle ear is functioning and can help diagnose fluid in the inner ear
- otoacoustic emissions testing, which enables the early detection of treatment-related hearing loss by measuring hair cell function in the inner ear
If a hearing loss is identified, we put together a comprehensive plan, which may include aural rehabilitation techniques, assistive listening devices, FM system technologies, hearing aid options, and other strategies to assist with communication.
The program also provides amplified telephones and teletypewriters (TTYs).
Speech Pathology and Audiology Research
The Speech and Hearing Center also participates in clinical research with the aim of improving the therapeutic options available to people with hearing, swallowing, speech, language, and voice deficits.
Our ongoing areas of research include:
- hearing loss in adult survivors of childhood cancer treated with radiation therapy
- ototoxicity rates in people who received cisplatin as part of treatment for osteosarcoma
- hearing loss associated with neurofibromatosis 2
- the role of tongue strength in swallow function
Past research initiatives have included:
- the role of the brain in the rehabilitation of speech and swallowing function
- the use of functional MRI and diffusion tensor imaging in assessing speech and swallow function during head and neck surgery
- the cellular dynamics of wound healing in the upper aerodigestive tract and the effects of radiation on the structures of speech and swallowing
MSK’s Speech and Hearing Center is composed of a multidisciplinary team of specialists who provide compassionate rehabilitative care. Team members include:
- Amy Budnick, Audiology
- Margaret L. Ho, Speech Pathology
- Louise Cunningham, Speech Pathology
- Katherine Kougentakis, Speech Pathology
Speech and Hearing Center
H-120, Howard Building
1275 York Avenue
Between 67th and 68th Street