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Image by Sander Dalhuisen

Swallowing therapy

Head and neck cancer and its associated treatment can be associated with swallowing problems, called dysphagia. Prior to treatment, head and neck cancer can be associated with either dysphagia or painful swallowing, limiting the amount of food you eat and the amount of effective nutrition you require. This can result in weight loss, low energy levels and fatigue. This may necessitate a change in the consistency or nature of your diet, or more rarely, insertion of feeding tube through your nose (nasogastric or Ryle’s tube) or through your abdominal wall (percutaneous endoscopic gastrostomy or PEG tube). 


Signs of swallowing issues:

  • Needing to take several swallows to clear you throat

  • Painful or difficulty swallowing

  • Having a dry mouth or throat

  • Coughing or choking after food or fluid intake

  • Having a gurgly or wet sounding voice after swallowing


Tests for swallowing issues:

  • Videolaryngoscopy: Here a small camera is passed into the back of your throat after an anaesthetic spray to look at your voicebox, particularly vocal cord movement and to test for aspiration (abnormal trickling of fluid past the vocal cords into the lungs)

  • Videofluoroscopy (VFS) or modified barium swallow (MBS): After swallowing a small amount of a contrast dye, a series of X-rays (fluoroscopy) is performed to assess what happens to the liquid. It specifically looks at how effective your swallowing is, whether the liquid is travelling through the appropriate passage or an abnormal one (called a fistula) or if the liquid is passing in to the windpipe in stead of the foodpipe (aspiration). 

  • Functional endoscopic evaluation of swallowing (FEES): Here a small camera is passed through the nose into the back of the throat and you are asked to swallow foods of different consistencies in order to see how effectively you are able to swallow them and if you have aspiration. Based on the findings you may be advised a change in diet. 


Treatment of swallowing problems

Addressing swallowing problems requires an assessment and a systematic treatment plan. Often this includes:

  • Re-training to help use your muscles to chew and swallow

  • Compensatory head positions to aid swallowing

  • Strategies and exercises to make you swallow better and safer

  • Eating softer foods or thicker fluids to help you swallow

  • Placing a feeding tube to ensure adequate nutrition

  • Performing a tracheostomy (an opening in the windpipe) to prevent aspiration

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