Changes to eating, speech and hearing

  • Head and neck cancers

    Follow up

    Your will have regular follow up appointments after treatment. These will include physical examinations and sometimes scans.

  • Head and neck cancers

    Wellbeing and recovery

    Looking after yourself by eating well, not smoking, cutting back on alcohol and being physically active can help your recovery.

  • Head and neck cancers

    Changes in how you look

    Treatments may change your appearance and affect your body image. There are different people and organisations to help support you.

  • Head and neck cancers

    Changes to eating, speech and hearing

    Treatments can cause changes that may make it difficult to hear or speak.

Surgery or radiotherapy may result in changes to the way you eat, drink or speak. Some people have changes to their hearing. These effects may be caused by swelling. They can improve as the swelling reduces or the tissues heal. But sometimes they are permanent.

A test called a videofluoroscopy shows what’s happening when you swallow. It helps your speech therapist find ways to make swallowing safer and easier for you. They'll show you exercises to help. A dietitian will give you advice on foods to eat and to avoid. If food is going into the lung some people need to be fed through a tube into their stomach.

Problems with your speech can be frightening and frustrating. Your speech therapist will show you exercises to help and they may give you special aids. If you have a problem with hearing, you’ll go to a specialist hearing clinic. They can recommend different aids to improve your hearing.

Changes to eating

Surgery and radiotherapy to the head and neck area may interfere with some of the actions or movements of your mouth, tongue or throat. This can make it more difficult to eat or drink.

Some of these changes are temporary and are caused by swelling in the mouth or throat immediately after treatment. As the swelling goes down, eating and drinking gradually improve. Although for some people, it may never be quite the same as before.

Some people find that after their treatment, they take longer to eat and can only manage certain foods. These changes may make you feel embarrassed and frustrated, and you may find it hard to eat with others.

It’s important to talk with your family and friends about how you’re feeling so that they can help. You can also talk to your specialist nurse. They will understand what you’re going through and may be able to offer help or put you in touch with other people who have experienced similar difficulties.

Your speech and language therapist and dietitian will help you learn to cope with any changes. They will assess your eating and swallowing at every stage and advise you on what you can do.

Swallowing test (videofluoroscopy)

If you’re having swallowing difficulties, you may be asked to have a special x-ray test of your swallowing called a videofluoroscopy. It gives a moving picture of what is happening in your mouth and throat when you swallow. It can show if anything gets stuck in your throat or if any food or drink goes down the wrong way. This helps the speech and language therapist see the best ways to make swallowing safer and easier for you.

This test is carried out in the radiotherapy department by a radiologist and the speech therapist. You will be asked to swallow different types of food, from liquid to semi-solid (like yoghurt) and solid (like a biscuit). A special substance is added to the food to make it show up on the x-ray. You may also be asked to try different techniques to see if they help when you swallow. The test takes about 30 minutes and is painless. The x-rays will be recorded on video or DVD.

The speech therapist will meet with you to discuss the results of the test. You’ll also be given advice on the type of food to eat – for example, drinks can be thickened to allow them to be swallowed safely.

If the results of the videofluoroscopy show that food or liquid is getting into the lungs, you may need to be fed directly into the stomach through a tube. Usually, this is only temporary until your swallowing recovers with the help of exercises and techniques taught by the speech and language therapist. Sometimes the feeding tube will be permanent.

Changes to speech and voice

Any change to your lips, teeth, tongue, soft palate or voicebox is likely to make your speech or voice sound different. This may mean that you have difficulty making one or two sounds or saying some words. It may sometimes be more severe, so people can’t easily understand what you are trying to say, or they can’t hear you.

For some people, a change in their speech or voice will only be a minor problem and it will return to normal, or near normal, as the tissues heal. For others, it will be more of a problem and will 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 and can give support and helpful advice.

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

  • Restorative dentistry – changes in the teeth or shape of the mouth cause speech problems. You can read more about restorative dentistry in our section on eating and drinking after treatment.
  • Speech and language therapy – including exercises to help you strengthen and control muscles used for speech.
  • 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. Therapy usually begins as soon as possible after surgery and normally continues after you go home. It is likely to involve exercises to improve the range and strength of mouth and tongue movements, or to find new ways to produce speech sounds. If you wear dentures, they may need to be changed. Sometimes, an individually-designed prosthesis is made to improve speech.

There are also special aids that your SLT will discuss with you, if necessary.

It will take time for you, and your family and friends to adjust to your changed speech or voice. When dealing with people you don’t know, it often helps to explain that you have had an operation that has made it difficult for you to talk.

Changes to hearing

Some people with cancer in areas of the head and neck such as the nasopharynx may have changes in their hearing. These can be due to the effects of the cancer itself or a side effect of treatment. If you have a problem with hearing after your cancer and treatment, you may be referred to a clinic that specialises in hearing problems. Appropriate treatment will then be recommended for you.

Hearing loss may be helped with hearing aids or cochlear implants (digital hearing aids that can recognise speech).

Sometimes the small tube between the ear and the throat (the Eustachian tube) can become blocked after treatment. The Eustachian tube helps to regulate air pressure in the ear, and if it’s blocked, it can affect hearing. If this happens, a simple operation to put in a tiny tube (grommet) can help the ear to drain and improve hearing. This is usually done under a local anaesthetic.

If you have ringing in the ears (tinnitus), you may be referred to a tinnitus management clinic where you can learn how to reduce its effects.