The Center for Speech and Swallowing Disorders provides diagnostic and therapeutic services for individuals of all ages who have problems with speech, language comprehension and production, or swallowing function. Speech pathology services are ordered through a physician referral. Evaluation and therapy procedures are provided to patients referred from:

• Section of Otolaryngology for patients with head and neck cancer, benign vocal tract lesions, as well as behavioral, developmental or functional speech and voice disorders
• Neonatal intensive care units (NICU) for sucking and swallowing problems in premature infants
• Pediatric inpatient units and outpatient clinics (including the Cleft Palate Clinic and the Friend Family Health Center) for speech and swallowing difficulties associated with developmental disorders, neurological disorders and craniofacial disorders
• Neurology and neurosurgery departments for patients with central nervous system (CNS) dysfunction resulting in aphasia, dysarthria and dysphagia
• Medical and surgical ICU's and general medicine department for patients with diagnoses which present risk factors for communication or swallowing disorders
• Oncology service for speech and swallowing disorders associated with head and neck cancer
• Outpatient speech and swallowing services are provided in the OHNS clinic in the Center for Advanced Medicine (DCAM) building on the University of Chicago Campus.

Diagnostic services include:

• Comprehensive speech-language evaluation
• Transnasal Esophagoscopy
• FEES
• Oropharyngeal Motility (OPM) study in conjunction with radiology
• Videoendoscopy for velopharyngeal disorders and/or videofluoroscopy for velopharyngeal disorders in conjunction with radiology
• Voice prosthesis placement and speech training for voice restoration after total laryngectomy

For more information, please contact the director of the Speech and Swallowing Disorders Service, Ellen MacCracken, M.S., CCC-SLP, at 773-834-7391

Speech Language Pathology in Head and Neck Cancer patients

Head and neck cancer may have a significant impact on communication and swallowing ability. In addition, the treatment modalities of surgery, chemotherapy and radiation therapy each have specific toxicities that may intensify when treatments are used in combination. Speech and swallowing problems related to head and neck cancer may range from mild and transient to severe and chronic, affecting the patient's daily life. Our goal is to optimize communication skills and swallowing function during and after cancer treatment.

For the patient with advanced head and neck cancer who receives chemoradiation therapy, the speech and swallowing program is protocol driven. Multidisciplinary intervention is necessary to achieve optimal functional outcomes. Services include:

• Consultation and counseling
• Instrumental, radiographic assessment of swallowing function through an oropharyngeal motility (OPM) study to evaluate the physiology of swallow function, and to assess the safety of oral feeding and risk for aspiration
• Administration of a functional performance status scale
• Individualized therapy

During inpatient admissions for head and neck cancer treatment, a primary goal is to maintain a basic level of safe oral food intake for quality of life purposes and for maximum rehabilitation outcome. The speech pathologist provides frequent monitoring of clinical status to reduce or prevent side effects of treatment, modify intervention goals, as well as assess adequacy of oral intake and potential need for enteral feeding support. The patient is also instructed in an exercise program of oral motor and swallowing maneuvers to maintain maximum muscle flexibility and function. This program is designed to maintain optimal speech and swallowing function.

After chemoradiation therapy, swallow disorders may range from mild to severe depending on the location of the tumor and the patient's response to treatment. Mild dysphagia (difficulty swallowing) could require a change in diet or the use of swallowing therapy techniques. Severe swallowing disorders after cancer treatment may prevent safe oral feeding. In this case, an alternate feeding source may be required on a short or long-term basis. The speech pathologist will conduct an OPM study and other standardized speech testing as needed, and will provide individualized therapy with the goal of assisting the patient in safely resuming the most natural oral diet and optimal communication skills.

Pre-operative counseling is a critical component of rehabilitation for patients receiving primary surgical treatment. Surgical resections of the head and neck may result in articulation, resonance or voice disorders. Objective assessment and aggressive therapy are provided to maximize communication and swallowing function after surgery. Patients receiving a total laryngectomy can benefit from surgical voice restoration with the placement of a silicone voice prosthesis, which promotes optimal voice rehabilitation with natural sound quality.

Pro-active intervention through pre-and post-treatment assessment, close clinical monitoring and rehabilitation services all facilitate optimal functional outcomes for the head and neck cancer patient. Speech pathology services are available through a physician referral by contacting the Speech and Swallowing Clinic at the University of Chicago Center for Advanced Medicine at 773-834-7391.