Rehabilitation

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.

Speech Rehabilitation

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.

Swallowing Rehabilitation

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.

At Johns Hopkins we believe in preventative medicine. Research and clinical experience has shown us the potential swallowing difficulties which may happen after treatment for head and neck cancers. We also know that therapy during treatment can reduce the chance of such problems. You will meet with a speech and swallowing therapist before your treatment so we can provide you with customized exercises. Strategies to rehabilitate swallowing function after treatment may include exercises that strengthen muscles or improve coordination, changes in posture, or special swallowing techniques. In some cases we will suggest specially-designed utensils or drinking cups. Changes in food consistencies are sometimes suggested for safety or ease of swallowing.