Hearing Assessment and Speech Therapy

Speech and language therapy is a study of communication disorders, that is any breakdown that occurs in the process of communication.

What is Speech & Language Therapy?

Speech and language therapy is a study of communication disorders, that is any breakdown that occurs in the process of communication including voice, fluency, speech clarity, understanding and production of language. Some Speech-Language Therapists (SLTs) are even specialised in treating swallowing disorders as swallowing share similar anatomical structures to speech (i.e. mouth and throat). SLTs work closely with surgeons and oncologists to make sure patients get the help needed.

For cancer patients

An SLT can assess and manage communication disorders and swallowing disorders resulting from cancer. Patients with head and neck cancer, brain cancer and even lung cancer are susceptible to speech and swallowing disorders. As such they may require speech and swallowing intervention as soon as the diagnosis is made or at some point during the treatment.

Cancer can affect the laryngeal nerves (nerves involved in voice production), causing vocal fold(s) paralysis. When that happens, your voice becomes breathy and you will not be able to speak in long sentences (as you run out of breath very easily). Vocal fold(s) paralysis can also cause swallowing problems since your vocal folds will not be able to close the airways completely during swallowing.

Due to this, mealtimes will be challenging with constant coughing, especially if the cancer affects the oral and pharyngeal cavities. Patients may experience difficulties in breaking down food and may also, cough and choke on food and drinks.

If cancer affects your speech and language area in the brain, then you may experience difficulties in communicating with others such as being unable to understand spoken language, unable to speak, or your speech becomes unclear.

Some cancer treatments can cause problems to your voice (frequency, pitch and intensity) and the ability to speak. Surgery for head or neck cancer may cause permanent changes that make communication or speaking difficult. Radiation can also cause problems ranging from short-term swelling of tissue (edema) and pain to long-term scarring and stiffening of tissue.

During a total laryngectomy, the larynx, including the vocal folds, is completely removed. A person who has had a total laryngectomy must learn new ways to speak using a different vibration source to replace the vibrations of the vocal folds.

Patients who have had radiation therapy or a partial laryngectomy can still speak using the vocal folds. There may be some changes to the quality of the voice including hoarseness, breathy voice and voice fatigue but speech therapy can help patients improve their quality of speech.

Speech and Language Therapy Techniques

At Sunway Cancer Centre, we offer personalised treatment as there are no two patients who will exhibit the same impairments and need. For example, a patient whose speech and language skills are affected will need speech and language therapy but not swallowing therapy. A patient with difficulties in swallowing will need diet modification, swallowing strategies to ensure safe swallowing, and swallowing exercises to improve the patient's swallowing functions. If the patient only has a voice problem, then voice therapy and techniques to improve the patient's voice quality will be offered.

The time required for speech and language therapy is highly dependent on the patients’ impairments, its severity, prognosis and how fast the patient responds to therapy.

Hearing Assessment - Ototoxicity Monitoring

Regardless of age, cancer patients and their caregivers may experience a variety of side effects caused by chemo and radiation therapies, such as reduced appetite, nausea and hair loss. However, they may not be aware that hearing loss is also one of a common side effect. Hearing loss can affect cancer patients during chemo and radiation therapies and in some cases, many years after the treatment. Platinum-based drugs such as cisplatin, carboplatin, and oxaliplatin, as well as strong antibiotics such as aminoglycoside will damage the inner ear(s), which may deteriorate over time. Radiotherapy on the other hand, when applied to the head, ear, or brain, may damage the inner ear(s) and cause inflammation, middle ear effusion and stiff ear bones.

Some common signs and symptoms of ear problems that cancer patients should take note of are:

  1. Difficulties understanding conversations
  2. Tinnitus [ringing, buzzing or tinkling sounds in the ear(s)]
  3. Dizziness or vertigo
  4. Ear pain or ear discharge
  5. Ear blockage

To aid the assessment and mitigation of potential hearing loss, our Sunway Medical Centre has a team of dedicated and skilled Audiologists to perform hearing assessments to determine the hearing threshold and the severity and type of hearing loss of the cancer patients before, during and after the chemo and radiation therapies. Besides providing the comprehensive assessments, the Audiologists also work closely with the Ear, Nose and Throat (ENT) Specialists to manage the hearing impairment in cancer patients if any. We believe that it is important to assist the cancer patient and/or the patient’s family to maintain effective communication throughout their cancer journey.

Kindly contact our Speech & Hearing Centre for more information at: