Our support services | Speech and language therapy
Speech and language therapy
Our team of speech and language therapists provide expert care and attention to patients who have communication and/or swallowing difficulties. Our therapists will meet with the patient at the very first hospital appointment along with the ear, nose and throat (ENT) consultant to ensure a continued approach to their diagnosis and ongoing care.
We see and treat patients who have voice complaints such as hoarseness, vocal fatigue, pain or discomfort on talking or a variable voice quality. They are advised on how to take care of their voices and shown exercises they can do at home.
Specialist tests
Some patients that are referred to our speech and language therapy team may benefit from specialist tests to study how they swallow; (how food moves from the mouth down to the digestive system). Our speech and language therapy team use a number of specialist tests to help provide the right assessment. These tests include:
Videofluoroscopy of swallowing
Videofluoroscopy is a special kind of x-ray that allows the speech and language therapist to investigate the structures and muscles used in swallowing. The test is completed in the barium suite on the 3rd floor of the outpatients building. Patients are asked to sit or stand in front of an x-ray machine and are given liquid barium followed by small amounts of barium coated foods. As the patient eats this food an x-ray recording of how he/she swallows is made. During the test, patients may be asked to put their heads in different positions or use different swallowing techniques to see if one swallowing technique works better than the other. The speech and language therapist will then review the recording to decide on the best follow-up therapy.
Fibreoptic endoscopic evaluation of swallowing (FEES)
Fibreoptic endoscopic evaluation of swallowing (FEES) is a test which uses a small flexible fibreoptic endoscope. A tiny camera (endoscope) is passed through the patient’s nose over the back of the mouth to a position slightly above the voice box. From this position the speech and language therapist can see exactly how well the patient is swallowing.
In order to make the patient more comfortable, the inside of the nose is coated with numbing gel before the tiny camera is inserted. Patients are then given foods or liquids that are tinted with food dye so that the speech and language therapist can see how the food is eaten, swallowed and where it goes. This test allows for a detailed assessment which assists the speech and language therapist, and determines when the patient is safe to start eating and what should be eaten.
Ongoing care for throat cancer patients
Patients who have had surgery to treat cancers of the pharynx and larynx (throat and voice box) may require specialist assessment, intensive therapy to help them speak and swallow again. The level of rehabilitation will vary according to the extent of surgery a patient has received and the severity of their speech or swallowing problems; patients who have a small cancerous growth may only require a few appointments with the speech and language therapist, however in more severe cases of laryngeal cancer where the entire voice box is removed, the speech therapists will ensure intensive follow-up speech therapy.
Following surgery and the specialist tests, there will be detailed discussions with the patient and family members, our team will have enough information to decide when the patient should start eating, the easiest and safest foods to eat, and any treatment techniques that will improve safety during eating. Some tests may be repeated to see how the patient is progressing and to decide whether any changes to the treatment plan are needed.
If required, some patients will be shown a series of exercises designed to get their swallowing muscles working properly again. Patients are carefully monitored and those that live within the hospital’s catchment area will have return visits and one-to-one appointments with the speech and language therapist. There are no hard and fast rules about the recovery period; some patients may require rehabilitation for a few months while others will require this for many years.
Communication
If a patient’s speech has become hoarse or the patient is experiencing pain or discomfort as result of throat and voice box cancer, the speech and language therapist will make the appropriate recommendations and guide patients through the path of learning to speak again.
If the patient’s entire voice box has been removed (known as a laryngectomy) then a special silicone valve is inserted into the tissues of a permanent hole through which they breathe in their neck and throat – this helps the patient achieve a ‘voice’ even though they no longer have a voice box.
