Rehabilitation for Head and Neck Cancers

Karen Belgard, AuD, audiologist, explains the changes in hearing in head and neck cancer patients can be more permanent over the course of their treatment and how this is treated. 

Changes in hearing tend to be more permanent when we're talking about treatment with chemotherapies like cisplatin or carboplatin. With those patients, we're often seeing some changes in hearing over their treatment plan or their course of treatment. That doesn't mean that there aren't things that we can do to help them hear better long term with hearing aids or some other assistive device that might help them on the telephone.

Some of our patients who are receiving radiation therapy directly to the ear or to the neck might have a temporary hearing loss that's related more to fluid and swelling and things in the ear. Those patients might benefit from a visit to one of the ear, nose and throat physicians or nurse practitioners for treatment for that type of hearing loss.

Karen Belgard, AuD, audiologist, describes the Ototoxicity Monitoring Program as the most comprehensive in southeastern Wisconsin. Patients are seen initially for baseline testing before starting treatment, during treatment and at the end of treatment to manage side effects medication or treatment may cause.

Head and neck cancer itself doesn't generally cause hearing loss. Unfortunately though, some of the treatments that we give patients with head and neck cancer can cause hearing loss or other issues with their ears.

That's why we want to — as part of our Ototoxicity Monitoring Program — see those patients before, during and after their treatment. We can carefully monitor their hearing let their oncologists and doctors know those results in case they need to make any change in the treatment plan.

Karen Belgard, AuD, audiologist, explains head and neck cancer treatments can cause side effects including hearing loss, ringing and buzzing noises in ears and possibly, balance issues. 

Unfortunately, some of the treatments for head and neck cancer can cause issues with the patient's ears. The patient may experience hearing loss, ringing or buzzing noises in their ears or balance issues.

Karen Belgard, AuD, audiologist, talks about medications that treat head and neck cancer can cause ototoxicity, or hearing loss. Some chemotherapy treatments and long-term antibiotics can cause hearing loss. 

There are a number of drugs or medications that can cause ototoxicity, hearing loss or ear issues. Some of them are the chemotherapy treatments, such as cisplatin or carboplatin. There are also some long-term antibiotics that can cause hearing loss as well. All of these medications are part of our Ototoxicity Monitoring Program.

Karen Belgard, AuD, audiologist, describes the head and neck cancer treatment team including doctors, audiologists, nurse practitioners, speech pathologists and physical therapists available to any patient having issues with their ears and balance during  head and neck cancer treatment. Hearing aids and services, diagnostics and physical therapy for balance issues are also provided. 

We're fortunate here to have audiologists, speech pathologists, physicians and nurse practitioners — as well as physical therapists — all available to help our patients that might be experiencing any sort of issues with their ears, hearing or balance as a result of their their chemotherapy or radiation treatments.

We provide:

• Hearing aids
• Hearing aid services
• Diagnostics
• Medical professionals who can treat other medical causes of hearing loss that that might require an antibiotic
• Surgery
• Physical therapist to deal with any balance issues that our patients might be experiencing

Karen Belgard, AuD, audiologist, describes the Ototoxicity Monitoring Program as the most comprehensive in southeastern Wisconsin. Patients are seen initially for baseline testing before starting treatment, during treatment and at the end of treatment to manage side effects medication or treatment may cause. 

I'm proud to say that we have one of the best and most comprehensive ototoxicity monitoring programs in southeastern Wisconsin. In our Ototoxicity Monitoring Program, we see patients initially for baseline testing prior to the start of treatment. That way we can get a good idea of what their hearing is like before any measures are taken.

We will also see them during that process — while they're receiving treatment — and there's different protocols depending on what medications or drugs the patients are taking.

At the end of treatment, we like to see them again for testing, so that we can deal with whatever effects that medication or treatment may have caused on their hearing. We alert the physicians and oncologists along the way through this monitoring process and keep them apprised of what's going on with their patients as well.

Karen Belgard, AuD, audiologist, describes the importance of the Ototoxicity Monitoring Program, including information sharing with the patient's treatment team and making sure the patient can hear throughout treatment to maintain communication. 

Sometimes, in the initial stage of treatment, we are just another appointment. Then, when a patient comes in and actually sees what we have to offer them — the counseling that we give them even just as part of our appointments, our contact information so they know how to reach us, the expectations — it changes.

Some patients don't know that hearing loss might be a consequence of their cancer treatment. Giving them this information is very helpful — going through results, following up with them and being a sounding board if they have questions. It becomes a very important part of the process that they weren't expecting it to be.

Karen Belgard, AuD, audiologist, explains that the Ototoxicity Monitoring Program treats patients with head and neck cancers as well as patients with other types of cancer who may receive therapies that affect the hearing. 

As part of our Ototoxicity Monitoring Program, we see patients with head and neck cancer, as well as other cancers that might be best treated with cisplatin or carboplatin. We offer:

• Diagnostic services
• Hearing aids services
• Monitoring services

We're always looking for any way that we can assist them to better function with any hearing loss or other ear-related issues that they might be having.

Karen Belgard, AuD, audiologist, describes the patient offerings of appointments, contact phone numbers, information and results reviews that make the Ototoxicity Monitoring Program an important and helpful part of the patient's head and neck cancer treatment process. 

As part of our Ototoxicity Monitoring Program, we like to look at the patient as a whole. We're not looking at them as just a cancer patient. We're looking at them as a human being, and we want to make sure that we can do whatever we can to ease them through this transition in their life.

We want to make sure that they're able to understand what changes might occur with their ears and their hearing, what we can do to help them deal with those changes if they do occur, counsel their family on what to expect and how to help that patient cope with any hearing loss that they might be experiencing and to just know that we're there for them.

Our goal isn't just to help treat your cancer. It's to help you manage any ramifications of that and to maintain or improve your quality of life

Karen Belgard, AuD, audiologist, describes the Ototoxicity Monitoring Program looking at the head and neck cancer patient as a whole individual and not their cancer treatment only. Coping assistance and counseling for the patient and their family is provided to help the patient maintain and improve their quality of life. 

One of the reasons we monitor patients who are receiving these medications is so we can pass that information to their prescribing physicians to may make changes to their treatment plan. The changes could be the dose of the medication, the medication itself or the mode of presentation. There's all sorts of things that might play into that.

We also are concerned with how the patients are hearing throughout this process. We want to make sure that, if patients are experiencing any hearing loss, we can help them stay a part of the process. We make sure they are able to hear at their appointments and contribute to their treatment plans.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains the importance of speech and swallow therapists collaborating with the head and neck cancer team.

It's important for our speech and swallow therapists to collaborate with the entire treatment team to make sure that, in the process of treating your cancer, we are not causing other problems. We will make sure that you can continue to be able to eat and communicate and do the things that can be impacted by treatment if we are not paying attention to them throughout the process.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains swallow therapy.

Swallow therapy is designed in a couple ways. It helps maintain swallow function as you go through radiation or — in the cases of other treatment options — helps improve or restore swallowing abilities if they had any changes after treatment.

Some of the changes that can happen during or after treatment for head and neck cancer can be pain with swallowing or just general difficulty. This can be anything from feeling like they cannot chew, feeling like foods do not go down very well, coughing or choking on foods.

This can also be just the inability to tolerate normal diets — to feel like you cannot eat the foods you would normally eat and feeling like you are losing weight or that you need a feeding tube or any other problem that can be associated with that treatment that results in the inability to eat.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains why head and neck cancer patient meets with the swallow therapy team before treatment starts.

Head and neck cancer patients can expect that swallow therapy will start before they ever go through treatment.

We will meet you before you begin to learn what your swallowing is like when things are considered more normal for you. We will talk you through what you can expect and give you exercises in a home program that you can start before treatment ever begins.

You can also expect that, as you go through your treatment, we will be with you throughout the process — that a speech therapist will be checking in with you frequently to make sure that you are continuing to swallow well and safely. We make sure that you are meeting the demands and needs that you have in terms of what you need to eat.

We continue to work with you even when treatment is done and continue to work with you for as long as you need. Some people will even come back and work with us years later if they are feeling like they have late effects from the treatment options that they went through. We are happy to work with anybody at any point in that journey.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, describes the first speech therapy visit for a head and neck cancer patient.

When you first come here, prior to ever having any treatment, we meet with you, get to know you, get to know your abilities with swallowing and explain what you can expect as you go through treatment.

We give you some basic swallow exercises to try to help strengthen your throat before you go through treatment and get your swallow in the best condition possible. We then meet with you throughout your treatment. We continue to check in with you and make sure that you're maintaining your diet, you're not losing weight, you're eating what you want or at least eating what you can, and getting you through as best as possible.

When treatment is done, we work with you to get you whatever your goal may be. Therapy can be as simple or as intensive as we want it to be. We work with you to figure out what you want and what you are willing to work toward.

We have many different treatment options to offer and do with you to get you swallowing again. Some of the swallow therapy treatments that we use are our manual therapy which is to improve flexibility if somebody feels tight or restricted after they've gone through treatment. We also can do trismus therapy — which targets jaw opening — if somebody feels like they can not open their mouth very wide or if they are having trouble with speaking or with chewing.

We also can recommend our McNeill Dysphagia Therapy Program, which is an intensive swallow therapy.  It is a boot camp approach to swallowing. You come in multiple days per week for several weeks, and we start with the basics to get you back to being able to eat meals again and eat what you want.

Dysphagia is our fancy word for swallowing problems, and we expect that anybody with head and neck cancer, going through any form of treatment, will experience dysphagia or swallowing problems to some extent.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains why head and neck cancer patients need speech therapy.

Head and neck cancer patients need speech therapy because all of our treatment options lead to some sort of speaking or swallowing problems.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains that people with head and neck cancer need speech therapy because the majority of our surgical and treatment options will result in a speech or swallowing problem of some sort.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains the role of the speech therapy pathologist during head and neck cancer treatment.

The role of the speech language pathologist varies depending on the person, but specifically in our head and neck cancer world. We work with speech and articulation — difficulties with speaking, swallowing problems, voice or voice disorders.

We work with trismus or jaw-opening difficulties, specifically helping with chewing. We also work with alternative means of communication following a big surgery, such as a laryngectomy, when the vocal cords have been removed.

We can also train you on alternative communication options following a big surgery, like a laryngectomy where the voice box and the vocal cords have been removed.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains how speech language pathologists specializing in head and neck cancer work with patients.

A speech-language pathologist that specializes in head and neck cancer works specifically with swallowing because the majority of patients will have problems with it. We also work with any speaking difficulties, such as making specific sounds or voice problems caused by treatments. We also can work with jaw opening and chewing and being able to open your mouth wider if it feels like it's limited.

We can also work with alternative means of communication if there has been a major surgery or if the voice box or the vocal cords have been removed or are damaged. We work to help you communicate with an alternative means through a variety of different options.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains when and why head and neck cancer patients are evaluated before treatment.

When somebody has head and neck cancer, we have them take part in speech therapy. This involves having them come in prior to ever having any treatment or surgery because we want to know what their swallowing is like before treatment. We make sure that things look good and look normal. We tell them what to expect as they go through treatment and explain what they can do to reduce the risk of having problems.

We can meet with patients throughout the treatment process and continue to check in. We can try different strategies or different therapy approaches to improve outcomes and to make things easier if they experience difficulties.

And we can continue to work with them after treatment is done and for as long as they need afterward to get them back to whatever their goals are and get them feeling like they are back to themselves.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains how long a feeding tube is used for head and neck cancer patients.

Typically, if you need a feeding tube, you will have it for as long as you need it. For a lot of people, this is just for the extent of treatment. As soon as treatment is done and they're feeling better, we can get them back to swallowing again. Then the tube can come out.

For others, if they feel like it's needed, it can stay in longer and for as long as they need it.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, describes when a feeding tube may be needed for a head and neck cancer patient during and after treatment.

A speech therapist can help determine if somebody needs a feeding tube, and it's typically something that we use as a little extra help. It is usually used when somebody is unable to get enough nutrition by eating. Swallowing has become more challenging, more difficult, and they feel like they cannot eat enough.

We work with our patients to make sure that they never stop eating throughout the treatment process. We want them to keep swallowing, and a feeding tube would only be used in addition to what they are able to eat by mouth.

Not every head and neck cancer patient will need a feeding tube. Typically, only a very small percentage of people that go through treatment will end up getting one. It is more common with surgery, but it is something that is usually decided between the entire team and the patient when they feel like it is necessary to help them to get proper nutrition throughout their treatment.

If it is decided to get a feeding tube, the person that receives that feeding tube will have it for as long as they need it. For a lot of people, this is just for the extent of treatment. As soon as treatment is done and they are feeling better, we can get them back to swallowing again that tube can come out. For others, if they feel like it is needed, it can stay in longer and for as long as they need.

Lindsey Nye, MS, CCC, SLP, speech language pathologist, explains that all Froedtert & MCW speech pathologists are trained specifically on the best therapy approaches.

Speech and swallow therapy is different here because all of the speech pathologists on our team are trained specifically in head and neck cancer. We know all of the common complaints and concerns. We know the best therapy approaches to help you go through treatment. We have worked with many others that have gone through this same diagnosis and this same treatment process. We are better able to help based on your specific needs because we know them.