Speech and voice after head and neck cancer treatment

We use our lips, teeth, tongue, mouth, nose and throat when we speak. If you have had surgery or radiotherapy to your head and neck area, your speech or voice may sound different. You may have difficulty making certain sounds or saying some words. Sometimes changes to your speech or voice may be more severe. This can mean people may not be able to easily understand you.

Thick, sticky saliva may make it difficult for you to speak. Reduced saliva causes a dry mouth. This can also make your mouth and throat feel uncomfortable when having longer conversations.

For some people, these changes are only a minor problem. Their speech or voice returns to normal, or near normal, as the area heals. For others, it may involve permanent changes to the way they speak or to their voice.

If you have speech or voice changes the following things may help:

• Do the exercises the SLT suggests. These can help you to strengthen and control the muscles used for speech and voice.
• Keep your throat healthy by not smoking and by drinking plenty of water.
• If speech problems are caused by changes in your teeth or shape of your mouth, a restorative dentist can help.

Your voice is the sound of your speech made at the level of your voicebox (larynx). Treatments that affect the larynx can affect your voice. The quality of your voice may become rougher (hoarse) more breathy, strained or quiet and may tire more easily.

Sometimes surgery to the vocal cords may be possible to improve your speech or any voice changes. Your SLT and specialist doctor will explain any treatments that may be helpful.

If people cannot understand you, it is normal to feel frustrated. But there are things you and the people you talk with can do to help.

Ask your family and friends to give you time to speak and to let you finish what you have to say. Encourage them to tell you if they do not understand anything. If they need to check what you mean, suggest they ask you questions with a yes or no answer.

Here are some tips:

• Choose a quiet place without distractions or background noise.
• Find a well-lit place.
• Face the person.
• Tell them you have difficulty with your speech.
• Sit up straight or stand up when speaking. This helps you breathe better.
• Speak slowly and carefully. Try to use short sentences and take a rest between them.
• Have a pen and paper with you so you can communicate by writing things down if you need to.

Sometimes, you may need to communicate in other ways. New technologies can help with this. If you are making a phone call, you can increase the volume on some phones so that your voice can be heard without straining. There are also helpful apps that convert the text you type into speech. Your SLT or occupational therapist can advise you about this.

You can also visit our head and neck cancer forum to communicate with people who have been affected by head and neck cancer, share your experience, and ask an expert your questions.