Speech Therapy’s Role in Head and Neck Cancer Presented By: Jodi Peabody, MS CCC-SLP Date: 09/09/2016

Screenings Patient questionnaire provided to all patients upon initial clinic visit. Education and information concerning potential difficulties with speech and or swallowing provided to patients flagged by questionnaire. Appropriate evaluation/ treatment provided and or scheduled as needed. May result in outpatient VFSS or outpatient speech therapy treatment

Benefits of Screening Providing education regarding immediate needs, if any. As well as attempting to minimize latent effects of treatment and maximize function. Immediate effect post-surgery Tolerance for oral intake Pain Changes in structure Aspiration Fistualas Latent Effects can be equally as devastating, and often appear years after treatment. Dysphagia that may appear years after treatment Vocal changes Reduced muscle range of motion/Stiffness

Oral Dysphagia Trismus- Reduced oral opening. Anterior spillage- Spilling of food or liquid out of oral cavity. (drooling) Mastication- May be limited secondary to dentition or surgical changes to oral structures. Xerostomia- Dry mouth/lack of saliva. Makes initiation of swallow difficult. Bolus control- Reduced lingual or labial function may result in poor containment or transport of bolus. Premature spillage into the pharynx- Bolus spills over the base of the tongue prior to initiation of swallow. Nasal regurgitation- Poor closure of nasal pharyngeal port.

Pharyngeal Phase Decreased motility- Poor laryngeal elevation – decreased pharyngeal propulsion of bolus. Decreased epiglottal inversion- increased risk for aspiration. Aspiration- Increased risk for recurrent pneumonia. Decreased motility- results in pharyngeal residue. Decreased cricopharyngeal opening- poor propulsion may not drive opening of cricopharyngus resulting in pharyngeal residue.

Esophageal Phase Solid dysphagia/ Dysmotility- Patient may report feeling of “food sticking” may benefit from esophogram vs. VFSS. Strictures- would require probable EGD. ©2015

Trismus Preventative Education Home Exercises Devices- Jaw Dynasplint, tongue depressors Continual screening- requires ongoing monitoring as it is easier to prevent than treat. ©2015

Xerostomia Dry mouth secondary to reduced or absent saliva flow. Can be secondary to chemo/ radiation or medications. Symptoms: taste disorders, painful tongue, increased need to drink water, decreased ability to initiate swallow, chapped lips, & oral candidiasis. Commercial Products Available: Mouth sprays Lozenges Gels

Nutrition Appetite and Taste- often diminished as side effect of cancer treatment. Oral Feeding- modified diets, calorie counts, pleasure feedings. Tube Feeding – Dobhoff vs. PEG/J-tube, may be used in conjunction with oral feeding. Supplements- shakes, vitamins, protein bars/drinks. Coordinate with nutritionist ©2015

Impact of Head and Neck Cancer on Communication Dysarthria secondary to structural change or nerve involvement. Voice changes Language or cognitive difficulties related to head and neck cancer or cancer treatment. ©2015

Resources Support for People with Oral and Head and Neck Cancer http://www.spohnc.org/index.php   National Foundation of Swallowing Disorders http://swallowingdisorderfoundation.com/ CancerCare http://www.cancercare.org/diagnosis/head_and_neck_cancer National Cancer Institute http://www.cancer.gov/types/head-and-neck Trismus information http://oralcancerfoundation.org/complications/trismus.php ©2015