Head and neck cancers and their assorted treatments often cause changes in speech and swallowing abilities. As much as possible, Johns Hopkins physicians try to preserve these functions, though many patients may still need some form of speech or swallowing rehabilitation. Our cancer center has two speech-language pathologists dedicated solely to the rehabilitation of head and neck cancer patients. They are included as part of the multidisciplinary team involved in patient care from diagnosis through completion of treatment.
For more information or to schedule an appointment or assessment, call 410-955-7895.
Our speech-language pathologists have extensive experience in rehabilitation of speech and voice after treatment for head and neck cancers. Collaboration with other professionals such as surgeons and prosthedontists allow for individualized care. We understand the importance of maintaining functional communication after treatment.
Our speech-language pathologists have particular expertise in speech rehabilitation after total laryngectomy. We offer a full range of therapy options for patients who have had their voice box removed, including teaching how to communicate by forcing air to the food pipe (esophageal speech); using external devices such as an electrolarynx to produce sound; and speaking while using tracheo-esophageal prostheses (TEPs) – small appliances that pass air from the windpipe to the throat. The clinic carries all sizes and brands of TEPs, and has someone available five days a week for changing the prostheses. We also offer pulmonary and olfactory rehabilitation for patients after laryngectomy. Customization of voice prosthesis and other devices can be considered for individuals with complicated problems.
To evaluate the vocal cords, a test called a videostroboscopy is used to provide a magnified, slow-motion movie of the voice box. During the test, a small, angled telescope will be placed into your mouth or a flexible telescope may be placed through your nose. You will be asked to make specific sounds to make your vocal cords vibrate. These movies are recorded and can be reviewed later.
At Johns Hopkins we believe in preventative medicine. Maintaining your quality of life during and particularly after radiation therapy is important to our team. We understand that for many people eating and communication are important for maintaining quality of life. The speech and swallowing therapist is the team member who will work with you before, during, and after radiation to keep your swallowing and communication as normal as possible.
Research has shown that even people with normal swallowing before radiation benefit from meeting with the speech and swallowing therapist. The muscles we use for swallowing may become weak during radiation and scarring after radiation may limit their ability to move freely. These problems can lead to symptoms like food sticking in your throat, things going down the wrong pipe, and things going up your nose when you swallow. Such problems can lead to health problems like pneumonia which can be quite serious. Fortunately, there are treatments that can help prevent these problems from occurring.
Active use of the swallowing muscles during radiation has been shown to protect them from weakening and scarring. There are two activities that you can do to use these muscles. The first important activity is to continue eating and drinking by mouth. Though you may need to alter your diet due to dry mouth and taste changes, we encourage you to eat and drink as normally as is possible. The speech and swallowing therapist can make suggestions on ways to keep eating during treatment. The second activity that is important for protecting your swallowing muscles is swallowing therapy. Research has shown that swallowing exercises need to be done throughout radiation to get the maximum benefit. The speech pathologist will provide you with the appropriate exercises. Recent research has shown that patients continuing to eat AND doing swallowing exercises have a 93% chance of returning to a normal diet after radiation. In comparison, if you don’t do either, you only have a 60% chance of returning to a normal diet. So what you do during treatment has a big impact on your outcomes. The speech pathologist is your partner to help you through this.
In addition to swallowing, some patients may have problems with speech, voice, or jaw stiffness during and after radiation. The speech pathologist can provide exercises and strategies to minimize these problems as well.
Our speech-language pathologists use a number of tests to look at swallowing abilities. Whenever possible we will look at how you swallow before treatment so that we can help you with and identify any difficulties. There are two main tests we will use for this purpose, video fluoroscopy and video endoscopy. Video fluoroscopy is a motion X-ray study where you may be given a variety of food consistencies mixed with barium, a white liquid that shows up clearly on an X-ray. The test measures swallowing ability from the mouth to the throat. Video endoscopy is done using a small flexible scope which is passed through the nose to the throat. This allows us to look at the swallowing area from above.
A representative from the speech and swallowing clinic will contact you PRIOR to the start of your radiation treatment to schedule appointments.
The phone number for the speech and swallowing clinic coordinator is 410-955-7895, option 2.
Other Types of Rehabilitation
The Johns Hopkins Cancer Rehabilitation Program is a comprehensive interdisciplinary program developed to provide outpatient rehabilitation to all survivors in need, whether you are newly diagnosed or long finished with treatment. We create customized programs to address a wide range of symptoms and diagnoses.
Our rehabilitation team has specialized training through the STAR Program™ (Survivorship Training and Rehab Program). We are uniquely qualified to understand the effects of cancer and cancer treatments on daily life. Our goal is to improve your daily function and quality of life.
For additional information about our comprehensive Cancer Rehabilitation program, visit the Sidney Kimmel Cancer Center website
Common conditions treated
- Cognitive difficulties
- Decline in balance
- Difficulty with walking
- Joint stiffness
- Numbness in feet or hands
- Poor endurance
- Postural changes
- Scar tissue restriction
- Swallowing disorders
- Bladder cancer
- Breast cancer (with and without reconstruction)
- Colon and rectum cancer
- Head and neck cancer
- Lung cancer
- Prostate cancer
- Spine and brain tumor
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