Speech and swallowing rehabilitation of the patient with head and neck cancer
- Jan S Lewin, PhD
Jan S Lewin, PhD
- Professor, Department of Head and Neck Surgery
- Section Chief, Speech Pathology and Audiology
- The University of Texas MD Anderson Cancer Center
- Marita S Teng, MD, FACS
Marita S Teng, MD, FACS
- Associate Professor and Residency Program Director
- Department of Otolaryngology
- Head & Neck Surgery Icahn School of Medicine at Mount Sinai New York, NY
- Tamar Kotz, MS CCC-SLP
Tamar Kotz, MS CCC-SLP
- Head and Neck Speech Pathologist
- Otolaryngology-Head and Neck Surgery
- Icahn School of Medicine at Mount Sinai
- Section Editors
- Bruce E Brockstein, MD
Bruce E Brockstein, MD
- Section Editor — Cancer of the Head and Neck
- Clinical Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Marvin P Fried, MD, FACS
Marvin P Fried, MD, FACS
- Section Editor — Head and Neck Surgery
- Professor and University Chairman, Department of Otorhinolaryngology - Head and Neck Surgery
- Montefiore Medical Center, Albert Einstein College of Medicine
Patients with head and neck cancer face multiple, often severe psychological and functional problems associated with the diagnosis and treatment of their disease. Rehabilitation and restoration of speech and swallowing are critical to optimize quality of life following treatment. (See "Quality of life in head and neck cancer".)
Functional outcomes depend upon multiple factors, including the site of origin and stage of the cancer, treatment modality, extent of resection, type of reconstruction, and quality of rehabilitation. Anatomical preservation does not necessarily translate into preservation of organ function. Even treatments that permit organ preservation, surgical (eg, laser, robotic) or nonsurgical (eg, radiation therapy alone or in combination with chemotherapy), frequently result in severe functional sequelae . (See "Locally advanced squamous cell carcinoma of the head and neck: Approaches combining chemotherapy and radiation therapy".)
The critical components of speech and swallowing rehabilitation for the patient with head and neck cancer will be reviewed here. Alaryngeal speech restoration is discussed separately. (See "Alaryngeal speech rehabilitation".)
THE INTERDISCIPLINARY TEAM
Patients with head and neck cancer have a variety of speech and swallowing problems. Many factors contribute, including:
●Loss of anatomic structure and continuity within the upper aerodigestive tract
- Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: initial results. Arch Otolaryngol Head Neck Surg 2000; 126:384.
- Pauloski BR, Rademaker AW, Logemann JA, et al. Pretreatment swallowing function in patients with head and neck cancer. Head Neck 2000; 22:474.
- Kotz T, Federman AD, Kao J, et al. Prophylactic swallowing exercises in patients with head and neck cancer undergoing chemoradiation: a randomized trial. Arch Otolaryngol Head Neck Surg 2012; 138:376.
- Carnaby-Mann G, Crary MA, Schmalfuss I, Amdur R. "Pharyngocise": randomized controlled trial of preventative exercises to maintain muscle structure and swallowing function during head-and-neck chemoradiotherapy. Int J Radiat Oncol Biol Phys 2012; 83:210.
- Logemann JA. Swallowing disorders after treatment for oral and oropharyngeal cancer. In: Evaluation and treatment of swallowing disorders, Berman D (Ed), Pro-Ed, Austin, TX 1998. p.251.
- Mittal BB, Pauloski BR, Haraf DJ, et al. Swallowing dysfunction--preventative and rehabilitation strategies in patients with head-and-neck cancers treated with surgery, radiotherapy, and chemotherapy: a critical review. Int J Radiat Oncol Biol Phys 2003; 57:1219.
- Langmore SE. Normal swallowing: The Endoscopic perspective. In: Endoscopic Evaluation and Treatment of Swallowing Disorders, Seils A (Ed), Thieme, New York 2001. p.37.
- Pauloski BR, Logemann JA, Rademaker AW, et al. Speech and swallowing function after oral and oropharyngeal resections: one-year follow-up. Head Neck 1994; 16:313.
- Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA. Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngol Head Neck Surg 1998; 118:616.
- Rademaker AW, Vonesh EF, Logemann JA, et al. Eating ability in head and neck cancer patients after treatment with chemoradiation: a 12-month follow-up study accounting for dropout. Head Neck 2003; 25:1034.
- Hutcheson KA, Lewin JS, Barringer DA, et al. Late dysphagia after radiotherapy-based treatment of head and neck cancer. Cancer 2012; 118:5793.
- Schwartz DL, Hutcheson K, Barringer D, et al. Candidate dosimetric predictors of long-term swallowing dysfunction after oropharyngeal intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2010; 78:1356.
- Kendall KA, McKenzie SW, Leonard RJ, Jones CU. Timing of swallowing events after single-modality treatment of head and neck carcinomas with radiotherapy. Ann Otol Rhinol Laryngol 2000; 109:767.
- Eisbruch A, Lyden T, Bradford CR, et al. Objective assessment of swallowing dysfunction and aspiration after radiation concurrent with chemotherapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2002; 53:23.
- Lewin JS, Hutcheson KA, Barringer DA, et al. Dosimetric predictors of long-term dysphagia following oropharyngeal IMRT. Int J Radiat Oncol Biol Phys 2008; 72(1 Suppl):S34.
- Lin YS, Jen YM, Lin JC. Radiation-related cranial nerve palsy in patients with nasopharyngeal carcinoma. Cancer 2002; 95:404.
- Martin S, Chung B, Bratlund C, et al. Eighteenth Annual Dysphagia Research Society Meeting Scientific Paper Sessions: Movement trajectories during percutaneous stimulation at rest of the hyolaryngeal muscles in head and neck cancer patients treated with radiation therapy. Dysphagia 2010; 25:354.
- Hutcheson KA, Lewin JS, Barringer DA, et al. Failed Organ Preservation: Chronic dysphagia five years or more after radiotherapy-based treatment of head and neck cancer. Oral presentation at 20th Annual Dysphagia Research Society Meeting. Toronto, Ontario, Canada: March 2012.
- Rosenthal DI, Trotti A. Strategies for managing radiation-induced mucositis in head and neck cancer. Semin Radiat Oncol 2009; 19:29.
- Murphy BA, Lewin JS, Ridner S, et al. Mechanisms of weight loss in patients with head and neck cancer who were treated with chemotherapy, ASCO Education Book Spring, 2006. p.340.
- Lewin JS. Dysphagia after chemoradiation: prevention and treatment. Int J Radiat Oncol Biol Phys 2007; 69:S86.
- Lewis SL, Brody R, Touger-Decker R, et al. Feeding tube use in patients with head and neck cancer. Head Neck 2014; 36:1789.
- Hutcheson KA, Bhayani MK, Beadle BM, et al. Eat and exercise during radiotherapy or chemoradiotherapy for pharyngeal cancers: use it or lose it. JAMA Otolaryngol Head Neck Surg 2013; 139:1127.
- Hutcheson KA, Barringer DA, Rosenthal DI, et al. Swallowing outcomes after radiotherapy for laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 2008; 134:178.
- Rosenthal DI, Lewin JS, Eisbruch A. Prevention and treatment of dysphagia and aspiration after chemoradiation for head and neck cancer. J Clin Oncol 2006; 24:2636.
- Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA. Speech and swallowing rehabilitation for head and neck cancer patients. Oncology (Williston Park) 1997; 11:651.
- Lazzara G, Lazarus C, Logemann JA. Impact of thermal stimulation on the triggering of the swallowing reflex. Dysphagia 1986; 1:73.
- Lazarus CL, Logemann JA, Pauloski BR, et al. Swallowing and tongue function following treatment for oral and oropharyngeal cancer. J Speech Lang Hear Res 2000; 43:1011.
- Allen K, Kuznicki MC, Mamel JJ. Nutrition support of the cancer patient. In: Swallowing Intervention in Oncology, Sullivan PA, Guilford AM (Eds), Singular Publishing Group, Inc, San Diego 1999. p.195.
- Logemann JA, Rademaker AW, Pauloski BR, et al. Site of disease and treatment protocol as correlates of swallowing function in patients with head and neck cancer treated with chemoradiation. Head Neck 2006; 28:64.
- Lazarus C, Logemann JA, Gibbons P. Effects of maneuvers on swallowing function in a dysphagic oral cancer patient. Head Neck 1993; 15:419.
- Shinn E, Lewin JS, Barringer DB, et al. The effect of adherence to swallowing exercises on swallowing outcomes in head and neck cancer patients treated with radiotherapy.19th Annual Dysphagia Research Society Meeting. San Antonio, TX: Dysphagia, 2011:443.
- Carroll WR, Locher JL, Canon CL, et al. Pretreatment swallowing exercises improve swallow function after chemoradiation. Laryngoscope 2008; 118:39.
- Logemann JA, Rademaker AW, Pauloski BR, Kahrilas PJ. Effects of postural change on aspiration in head and neck surgical patients. Otolaryngol Head Neck Surg 1994; 110:222.
- Lazarus CL. Effects of radiation therapy and voluntary maneuvers on swallow functioning in head and neck cancer patients. Clin Commun Disord 1993; 3:11.
- Kulbersh BD, Rosenthal EL, McGrew BM, et al. Pretreatment, preoperative swallowing exercises may improve dysphagia quality of life. Laryngoscope 2006; 116:883.
- Carnaby-Mann G, Crary M, Amdur R, Schmalfuss I. Preventative exercise for dysphagia following head and neck cancer (abstract). Dysphagia 2007; 22:381a. Data presented at the 15th Annual Dysphagia Research Society Meeting, March 8-10, 2007, Scientific Poster Sessions, Vancouver, British Columbia, Canada.
- Starmer HM, Yang W, Raval R, et al. Effect of gabapentin on swallowing during and after chemoradiation for oropharyngeal squamous cell cancer. Dysphagia 2014; 29:396.
- van Gogh CD, Verdonck-de Leeuw IM, Boon-Kamma BA, et al. The efficacy of voice therapy in patients after treatment for early glottic carcinoma. Cancer 2006; 106:95.
- Lewin JS, Hutcheson KA, Smith BG, et al. Early experience with head and neck lymphedema after treatment for head and neck cancer. Multidisciplinary Head & Neck Cancer Symposium. Chandler, Arizona, 2009.
- Smith BG, Hutcheson KA, Little LG, et al. Lymphedema outcomes in patients with head and neck cancer. Otolaryngol Head Neck Surg 2015; 152:284.
- Pauloski BR, Logemann JA, Rademaker AW, et al. Speech and swallowing function after anterior tongue and floor of mouth resection with distal flap reconstruction. J Speech Hear Res 1993; 36:267.
- Logemann JA, Pauloski BR, Rademaker AW, et al. Speech and swallow function after tonsil/base of tongue resection with primary closure. J Speech Hear Res 1993; 36:918.
- McConnel FM, Pauloski BR, Logemann JA, et al. Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing. Arch Otolaryngol Head Neck Surg 1998; 124:625.
- McConnel FM, Logemann JA, Rademaker AW, et al. Surgical variables affecting postoperative swallowing efficiency in oral cancer patients: a pilot study. Laryngoscope 1994; 104:87.
- Hammoudi K, Pinlong E, Kim S, et al. Transoral robotic surgery versus conventional surgery in treatment for squamous cell carcinoma of the upper aerodigestive tract. Head Neck 2015; 37:1304.
- Genden EM, Kotz T, Tong CC, et al. Transoral robotic resection and reconstruction for head and neck cancer. Laryngoscope 2011; 121:1668.
- Hutcheson KA, Holsinger FC, Kupferman ME, Lewin JS. Functional outcomes after TORS for oropharyngeal cancer: a systematic review. Eur Arch Otorhinolaryngol 2015; 272:463.
- Hutcheson KA, Jantharapattana K, Barringer DA, et al. Functional and oncological outcomes of primary versus salvage transoral laser microsurgery for supraglottic carcinoma. Ann Otol Rhinol Laryngol 2012; 121:664.
- Pauloski BR, Logemann JA. Impact of tongue base and posterior pharyngeal wall biomechanics on pharyngeal clearance in irradiated postsurgical oral and oropharyngeal cancer patients. Head Neck 2000; 22:120.
- Kimata Y, Sakuraba M, Hishinuma S, et al. Analysis of the relations between the shape of the reconstructed tongue and postoperative functions after subtotal or total glossectomy. Laryngoscope 2003; 113:905.
- Logemann JA. Anatomy and physiology of normal deglutition. In: Evaluation and treatment of swallowing disorders, Berman D (Ed), Pro-Ed, Austin, TX 1998. p.29.
- Logemann JA. Deglutition disorders in cancer of the head and neck. In: and Neck Oncology: Clinical Management, Kagan AR, Miles J (Eds), Pergamon, New York 1989. p.155.
- Sun J, Weng Y, Li J, et al. Analysis of determinants on speech function after glossectomy. J Oral Maxillofac Surg 2007; 65:1944.
- Bressmann T, Sader R, Whitehill TL, Samman N. Consonant intelligibility and tongue motility in patients with partial glossectomy. J Oral Maxillofac Surg 2004; 62:298.
- Ruhl CM, Gleich LL, Gluckman JL. Survival, function, and quality of life after total glossectomy. Laryngoscope 1997; 107:1316.
- Furia CL, Kowalski LP, Latorre MR, et al. Speech intelligibility after glossectomy and speech rehabilitation. Arch Otolaryngol Head Neck Surg 2001; 127:877.
- Marunick M, Tselios N. The efficacy of palatal augmentation prostheses for speech and swallowing in patients undergoing glossectomy: a review of the literature. J Prosthet Dent 2004; 91:67.
- Humbert IA, Poletto CJ, Saxon KG, et al. The effect of surface electrical stimulation on hyolaryngeal movement in normal individuals at rest and during swallowing. J Appl Physiol (1985) 2006; 101:1657.
- Hillman RE, Walsh MJ, Wolf GT, et al. Functional outcomes following treatment for advanced laryngeal cancer. Part I--Voice preservation in advanced laryngeal cancer. Part II--Laryngectomy rehabilitation: the state of the art in the VA System. Research Speech-Language Pathologists. Department of Veterans Affairs Laryngeal Cancer Study Group. Ann Otol Rhinol Laryngol Suppl 1998; 172:1.
- Jacobs JR, Logemann J, Pajak TF, et al. Failure of cricopharyngeal myotomy to improve dysphagia following head and neck cancer surgery. Arch Otolaryngol Head Neck Surg 1999; 125:942.
- Moerman MB. Cricopharyngeal Botox injection: indications and technique. Curr Opin Otolaryngol Head Neck Surg 2006; 14:431.
- Shaker R, Easterling C, Kern M, et al. Rehabilitation of swallowing by exercise in tube-fed patients with pharyngeal dysphagia secondary to abnormal UES opening. Gastroenterology 2002; 122:1314.
- Blaugrund SM. Laryngeal framework surgery. In: Phonosurgery: Assessment and Surgical Management of Voice Disorders, Ford CN, Bless DM (Eds), Raven Press, New York 1991. p.183.
- Rademaker AW, Logemann JA, Pauloski BR, et al. Recovery of postoperative swallowing in patients undergoing partial laryngectomy. Head Neck 1993; 15:325.
- Logemann JA, Gibbons P, Rademaker AW, et al. Mechanisms of recovery of swallow after supraglottic laryngectomy. J Speech Hear Res 1994; 37:965.
- Laccourreye H, Laccourreye O, Weinstein G, et al. Supracricoid laryngectomy with cricohyoidopexy: a partial laryngeal procedure for selected supraglottic and transglottic carcinomas. Laryngoscope 1990; 100:735.
- Bron L, Brossard E, Monnier P, Pasche P. Supracricoid partial laryngectomy with cricohyoidoepiglottopexy and cricohyoidopexy for glottic and supraglottic carcinomas. Laryngoscope 2000; 110:627.
- Dworkin JP, Meleca RJ, Zacharek MA, et al. Voice and deglutition functions after the supracricoid and total laryngectomy procedures for advanced stage laryngeal carcinoma. Otolaryngol Head Neck Surg 2003; 129:311.
- Lewin JS, Hutcheson KA, Barringer DA, et al. Functional analysis of swallowing outcomes after supracricoid partial laryngectomy. Head Neck 2008; 30:559.
- Gates GA, Ryan W, Cantu E, Hearne E. Current status of laryngectomee rehabilitation: II. Causes of failure. Am J Otolaryngol 1982; 3:8.
- Davis RK, Vincent ME, Shapshay SM, Strong MS. The anatomy and complications of "T" versus vertical closure of the hypopharynx after laryngectomy. Laryngoscope 1982; 92:16.
- THE INTERDISCIPLINARY TEAM
- COMPLICATIONS AFTER RADIATION THERAPY
- Fibrosis and neuropathy
- Xerostomia and mucositis
- Gastrostomy tube placement
- - Primary tumor site
- - Treatment
- Other complications
- POSTSURGICAL COMPLICATIONS
- Minimally invasive techniques
- Oral cavity and oropharyngeal cancers
- - Treatment
- Laryngeal and hypopharyngeal cancers
- - Rehabilitation following laryngopharyngectomy
- - Rehabilitation following total laryngectomy