Voice, Speech & Swallowing Therapy

Swallowing disorders, called dysphagia, can affect the mouth, throat or esophagus. Our swallowing team has expertise in assessing and treating dysphagia.

Evaluation will include a clinical evaluation and instrumental study, using either video fluoroscopy (a moving x-ray), or endoscopy (a small camera).

Treatment may include swallow strategies, modifications in your diet, and/or exercises to improve your swallow.

Symptoms of dysphagia may include:

• Coughing while eating or drinking
• Difficulty initiating a swallow
• The sensation of food or liquid being “stuck” in your throat
• Pain when swallowing
• Changes in your voice quality when eating and drinking
• Food/liquid leaking out of your mouth or nose

If you have symptoms of dysphagia, ask your doctor for an order for swallow evaluation and treatment.

Inpatient Care

Many medical conditions that result in hospitalization can negatively impact swallowing, even if only for a short period of time. The consequences of food and liquid “going down the wrong way” (aspirating) are more significant when you are sick and in the hospital.

Our swallowing team has expertise in the assessment and treatment of dysphagia. Your evaluation will begin with a clinical evaluation at your bedside. If further diagnostic testing is needed, an instrumental study, using either video fluoroscopy (a moving x-ray), or endoscopy (a small camera) with be performed.

After your evaluation, the speech-language pathologist will discuss your results and recommendations for your care with you and the rest of your medical team.

Every person treated for head and neck cancer faces unique challenges. Physical and functional changes caused by surgery, radiation, or chemotherapy require a personalized approach to care. Our head and neck cancer team looks at your care as a whole person, not just your diagnosis.

We will work with you to address concerns such as:

• Voice and swallow preservation exercises
• Swallowing difficulty (dysphagia)
• Xerostomia (dry mouth)
• Pain management
• Voice changes
• Muscle stiffness and fibrosis
• Lymphedema

For our patients who have had a laryngectomy, we provide:

• Pre- and post-laryngectomy counseling
• Electrolarynx (artificial larynx) training
• Stoma care (such as Heat and Moisture Exchanger, or HME, fitting and teaching)
• Tracheoesophageal prosthesis (TEP) care and management

At BIDMC, we know that a head or neck cancer diagnosis is life altering. Our team of speech-language pathologists are devoted to supporting you at any stage in your journey with this disease.

Inpatient Care

We may see you pre-operatively to assess your baseline voice, speech, and swallowing condition and to prepare you for your treatment. We will also see you post-operatively to help you return to eating and communicating.

Our team works with your surgeon to provide holistic, coordinated care throughout your hospital stay and your transition to outpatient care.

Voice disorders (called dysphonia) can happen for many reasons. Examples include excess muscle tension, vocal fold injuries, paralysis or paresis, dystonia, infections, and neurological conditions.

Symptoms may include:

• Hoarseness
• Voice strain and/or fatigue
• Difficulty speaking loudly
• Reduced pitch range
• Voice turning on and off

Your evaluation will include a clinical evaluation and a laryngeal stroboscopy. The stroboscopic examination allows us to understand the nature of your vocal folds’ vibration so we can understand how to best help you.

Our voice team is trained in many specialized methods to evaluate and treat voice problems. We create a care plan that is tailored to your specific needs.

Specialized voice care is available for:

• Professional singers and actors
• Gender-affirming voice treatment

The voice and speech changes associated with Parkinson’s Disease are best treated using a method that is designed specifically for this condition. Our team has been trained in the Speak Out! protocol, developed by the Parkinson Voice Project.

When needed, our team will perform a laryngeal stroboscopy to rule out other causes of voice dysfunction.

Our team also provides evaluations before deep brain stimulation (DBS) to measure your voice and speech before the procedure. This gives us a baseline and helps guide future care if changes happen after surgery.

Our team of voice and upper airway speech-language pathologists has specialized training in treatments for chronic cough and functional breathing disorders, such as paradoxical vocal fold motion (also called inducible laryngeal obstruction, or ILO) and irritable larynx syndrome.

Your evaluation will include a clinical evaluation and a laryngeal examination with stroboscopy to help us understand all of the factors involved in your problem. We will review your suggested plan of care with you at the end of the evaluation visit.

With some medical conditions, you might require a tracheostomy. This is a procedure that involves creating a hole in your trachea (windpipe) from outside of your body. The hole helps oxygen reach your lungs but makes speaking and swallowing difficult.

If you have a tracheostomy during your inpatient stay, our speech-language pathologists will work with you to:

• Optimize your ability to swallow
• Evaluate you for speaking valve use, in collaboration with nursing and respiratory therapy

What is a speaking valve?

A speaking valve is a one-way valve that is placed at the outside end of the tracheostomy tube. The valve allows you to breathe in through the tube, but it closes when you exhale. This closure directs the air through your vocal folds and upper airway for voice and speech production.

The ability to express yourself and to understand what others around you are saying is important to your ability to understand and participate in your inpatient care and communicate with loved ones.

If your language and cognitive-linguistic function are negatively impacted by your medical condition, our team will evaluate you and formulate an effective communication plan.

A laryngeal stroboscopy is a test to help us understand your voice disorder. We use a nasal laryngoscope to perform the test. A nasal laryngoscope is a thin, flexible, fiberoptic camera we thread through your nasal passage to your throat so that we can see your larynx (voice box).

We utilize a special stroboscopic light during the test. This allows us to see the vibration of your vocal folds in slow motion while you make sound. Watching the vocal folds in vibration allows us to better define the nature of your voice disorder and its cause. Our examinations are reviewed in collaboration with a laryngologist (a voice-specialized ENT).

What To Expect

• You will come to the Voice, Speech, and Swallowing office for your test. 
• We will spray your nasal passages with a decongestant and topical lidocaine to make the exam more comfortable, though you are free to decline this if desired. 
• You will feel pressure in your nose during the test. 
• The examination is recorded to facilitate review by our team and the collaborating laryngologist. 
• There is no special preparation needed for this test, and you can take your medications as usual.

A Modified Barium Swallow (MBS)/Video Swallow Study is a test of swallowing that uses a moving x-ray called fluoroscopy to watch you swallow. The images are recorded like a movie so our team can closely examine your swallowing. The test is performed in the radiology suite by a speech-language pathologist and a radiology technician. This test will help us understand the nature of your swallowing difficulty and the best way to treat it.

What To Expect

• You will go to the Radiology Department for your test.
• You will be told where to stand or sit so the x-ray can see the structures of your mouth and throat.
• You will eat small amounts of food and liquid containing barium, which allows us to see it in the fluoroscopic images.
  • The amount of barium used in the test is small.
• The speech-language pathologist may try some techniques during the test to help you swallow better.
• The test typically takes less than 15 minutes, but your appointment time is an hour to allow us to talk to you about your symptoms, prepare, and provide you with our recommendations.
• There is no special preparation needed for this test, and you may take your normal medications.

Directions to Radiology for MBS/Video Swallow Study

Outpatient Videofluoroscopic Swallowing Evaluations are performed in the Radiology Department, either at the West Campus Rosenberg Building on One Deaconess Road or on the East Campus, in the Rabb Building.

On the West Campus, patients can valet park at the Rosenberg Building, take the elevators to the third floor and check in at the outpatient Radiology Department.

On the East Campus, patients can use the Main Entrance at 330 Brookline Avenue. Park near the Feldberg lobby and ask the staff at the information desk to guide you to the Rabb Building. Take the elevator to the third floor and check in at the outpatient Radiology Department.

Fiberoptic Endoscopic Evaluation of Swallowing (FEES) is a test of swallowing that uses a nasal endoscope to watch you swallow. A nasal endoscope is a thin, flexible, fiberoptic camera we thread through your nasal passage to your throat. This test will help us understand the nature of your swallowing difficulty and the best way to treat it.

What To Expect

• You will come to the Voice, Speech, and Swallowing office for your test.
• You will feel pressure in your nose during the examination.
• During the test, you will eat food and liquid with food coloring in it.
• The exam will be recorded to video so that the clinician can review it in detail upon completion.
• The typical duration of the test is less than 10 minutes, but your appointment time is an hour to allow us to talk to you about your symptoms, prepare and provide you with our recommendations.
• There is no special preparation needed for the test, and you may take your normal medications.