Speech and voice after head and neck cancer treatment

Treatment for head and neck cancer may cause changes to speech and voice or ability to communicate.

Changes to speech and voice

We use our lips, teeth, tongue, mouth, nose and throat when we speak. If you have had an operation or radiotherapy to your head and neck area, your speech is likely to sound different. You may have difficulty making certain sounds or saying some words. People may not be able to easily understand what you are trying to say. Or they may not be able to hear you clearly. Dryness can also make your mouth and throat feel uncomfortable when having longer conversations.

The sounds you make for speech (your voice) are made by the voicebox (larynx). Treatments that affect the larynx can affect your voice. Your voice may be hoarse, tire more easily or be quieter than normal. If you have had your larynx removed, you will need to learn new ways to communicate.

For some people, these changes are only a minor problem. Their speech or voice returns to normal, or near normal, as the affected area heals. For others, it is more of a problem. It can cause permanent changes to the way they speak.

Losing the ability to talk, even for a short time, can be frightening and frustrating. In the first few days after your operation, you could communicate by writing things down. That will allow you to let people know what you need. A speech and language therapist (SLT) will be involved in your recovery from an early stage. They can give support and helpful advice.

The following things may help if you have speech or voice changes:

  • Restorative dentistry – if speech problems are caused by changes in the teeth or shape of the mouth.
  • Speech and language therapy – including exercises to help you strengthen and control muscles used for speech and voice.
  • Keeping your throat healthy by not smoking and by drinking plenty of water.
  • Aids to help you communicate.

Speech therapy

Speech therapy can help you learn to communicate in the clearest and most effective way possible. Your speech and language therapist (SLT) normally assesses and advises you before surgery. Therapy usually begins as soon as possible after surgery and normally continues after you go home.

Your SLT assesses changes in your speech and voice. They can give you advice and treatments to help with any changes. If you have changes to your voice, they can give you advice on how to take care of your throat. They may give you exercises to:

  • help you make your voice heard without straining
  • increase how long you can easily talk for.

The exercises may feel like hard work at times, but it is important to keep going with them. It is usually more effective to do them for a few minutes, several times a day, rather than for a longer time, less often. You may find it helpful to make a chart of the exercises you need to do and the times you do them.

Apps such as So2Speak® can help guide you through the exercises, remind you when to do them and keep track of how often you do them. Always talk to your SLT before using any apps.

It can take time for you, and your family and friends, to adjust to changes in your speech or voice. The reactions of people you do not know may be harder to get used to. You can explain that you have had an operation that has made it difficult for you to talk. This can help put yourself and other people at ease.

Tips for communicating

If people cannot understand you, it is normal to feel frustrated. But there are things you, and the people you communicate with, can do to help.

Ask your family and friends to give you time to speak and to let you finish what you have to say. Encourage them to tell you if they do not understand anything. If they need to check what you mean, suggest they ask you questions with a yes or no answer.

Here are some tips to help with communication:

  • Choose a quiet place with no distractions or background noise.
  • Find a well-lit place to meet so that you can clearly see each other's faces.
  • Face the person.
  • Tell them you have difficulty with your speech.
  • Sit up straight or stand up when speaking. This helps you breathe better.
  • Speak slowly and carefully. Try to use short sentences and take a rest between them.
  • Keep a pen and paper with you so that you can communicate by writing things down if you need to.

Other ways of communicating

Sometimes, you may need to communicate in other ways. New technologies can help with this.

If you are making a phone call, you can increase the volume on some phones so that your voice can be heard without straining.

There are also helpful apps that convert the text you type into speech. Your specialist doctor or nurse can tell you more about this. You might also find the Talking Mats® app useful. It uses images to help you communicate quickly. It is free to download and works on most mobile devices. Ask your speech and language therapist (SLT) for more information.

About our information

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Dr Chris Alcock, Consultant Clinical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.