Head and Neck Cancer and Voice
Patients who have lost voice function to head and neck cancer often need specialized care to restore their quality of life. Specialists from the Voice and Speech Laboratory offer trachea-esophageal puncture management, as well as specialized therapy to retrain patients to speak without vocal folds.
A thorough evaluation and biopsy are needed to determine if laryngeal lesion is cancerous. In the evaluation process, the voice team looks at all of the factors involved, including your life, health and family history and the close up stroboscopic images of the lesion to guide their decision making and recommendations. If you have voice changes lasting more than 2 weeks or persistent throat pain or discomfort, come in for an evaluation.
The effects of radiation therapy on the voice will be variable depending on where you were radiated, the intensity of the radiation and the length of your treatment. The more your larynx is directly in the beam of the radiation, the more swelling and pain may impact your voice. In addition, there may be increased stiffness of the neck, throat and larynx that comes on many years after the radiation is finished. A specialized voice team can help you work with exercises to minimize the impact of radiation therapy.
During radiation therapy, swallowing and speaking can be very painful, but after the treatment is complete and the swelling subsides most people are able to return to speaking and swallowing. There may be some variation depending on whether you underwent surgical treatment for your cancer as well. Your voice team can help you understand what to expect given the specifics of your cancer and your treatment plan.
A laryngectomy is a surgery where the larynx (voice box) is removed. Most often this is due to extensive cancer of the larynx; however, some laryngectomy is due to extensive throat/laryngeal trauma or injury.
A laryngectomy results in the loss of the larynx and the vocal folds that you used to speak. The airway (trachea) is directed to the front of the neck and therefore breathing is done through the neck. The feel of swallowing may be different due to the changes in your anatomy, however, swallowing function is generally intact. In order to talk, your voice team will work with you to use alternative strategies. These may include an electrolarynx, trachea-esophageal puncture or esophageal speech.
A tracheo-esophageal puncture is a surgical procedure after a laryngectomy wherein a small hole is created between the trachea (airway) and the esophagus (food tube). A one-way valve is placed into the hole and this is used to create voice.
A glossectomy is a surgical procedure where part or all of the tongue is removed, most likely due to cancer. Your function after a glossectomy will depend on how much and what parts of your tongue needed to be removed. If large portions of the tongue have had to be removed, articulating speech may be difficult or impossible. If the base of the tongue has been removed, swallowing will be problematic. People who have the need for a glossectomy are supported by a multidisciplinary specialized team to address their specific challenges.
Source: Barbara M. Wilson Arboleda, M.S., CCC-SLP