Stanford Head and Neck Center


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Rehabilitation Program

Swallowing Care

Our experts have extensive experience evaluating and treating swallowing disorders, sometimes referred to as dysphagia.  Our speech-language pathologists use a number of tests to look at swallowing abilities. There are two primary tests we use to assess swallowing, video fluoroscopy and video endoscopy. Video fluoroscopy is a motion X-ray test where you will be given a variety of food consistencies mixed with barium, a white liquid that shows up clearly on an X-ray. The test measures swallowing ability from the mouth to the throat and to the esophagus if necessary. Video endoscopy is done using a small flexible endoscope that is passed through the nose to the throat. This allows us to look at the swallowing area from above.  We can then watch as you swallow different foods and liquids to see how they go through the throat.  These tests allow us to understand how your swallowing muscles are functioning so that we can customize your treatment plan.

At the Stanford Cancer Center we believe in preventative medicine. Research and clinical experience has shown us that swallowing problems can be common after treatment. We also know that therapy during treatment reduces the chance of swallowing problems. Keeping your swallowing muscles strong and active during radiation therapy is the best way to ensure they continue to work for years to come.  Strategies to rehabilitate swallowing function after treatment may include exercises that strengthen muscles or improve coordination, changes in posture while swallowing, or special swallowing techniques to make the food and liquid go down easier and safely. In some cases we will suggest specialty-designed utensils or drinking cups. Changes in food consistencies are sometimes suggested for safety or ease of swallowing.

What is dysphagia?

Dysphagia refers to difficulty in swallowing.  Some symptoms of dysphagia include a sense of food/liquid getting caught in the mouth or throat, coughing/choking like things are going down the “wrong pipe”, difficulty chewing, and/or longer time needed to eat/drink.  Dysphagia can lead to other problems like weight loss or pneumonia from food/liquids entering the lungs.  Head and neck cancer and the treatments use to eliminate cancer are known risk factors for dysphagia.  The speech language pathologist can provide preventative and rehabilitative intervention for dysphagia.

What is trismus?

Trismus occurs when a person has difficulty opening their mouth fully.  Trismus can lead to difficulty with eating, dental care, and speech.  Trismus often gets worse over time if not treated.  Surgery and radiation to the head and neck region are known risk factors for trismus.  Trismus prevention is an important part of the care provided by the speech language pathology team.


Swallowing and speech rehabilitation for head and neck cancer

Nutrition for head and neck cancer

Modified barium swallow

This fluoroscopic video demonstrates a strong and efficient swallow that clears the dark liquid contrast through the throat into the esophagus (food pipe).

Modified barium swallow

This fluoroscopic video demonstrates a swallow that lacks the strength to push the dark liquid contrast through the throat into the esophagus (food pipe).  As a result, the contrast is seen to drip into the airway leading to aspiration.

Fiberoptic endoscopic evaluation of swallowing

This endoscopic evaluation demonstrates assessment of airway and swallowing following a supracricoid partial laryngectomy.  This surgery involves removal of multiple structures of the voice box that typically offer airway protection during swallowing.  By using a compensatory swallowing strategy taught by the speech and swallowing therapist, this patient was able to resume a nearly normal diet.