Swallowing Disorders Center
At the UPMC Swallowing Disorders Center a team of physicians and speech-language pathologists focuses its expertise on diagnosing and treating the specific causes of swallowing disorders.
Our clinical goals are to identify the cause of the swallowing problem and to restore swallowing function to a level as normal as possible in order to improve quality of life and nutrition. Our mission also includes clinical research and education for patients, families, and health care professionals.
About Us
The UPMC Swallowing Disorders Center includes a multidisciplinary team composed of ear, nose, and throat specialists (otolaryngologists) and speech-language pathologists who specialize in evaluating and treating swallowing disorders.
We work closely with other specialists such as dietitians, gastroenterologists, neurologists, radiologists, rehabilitation physicians, thoracic surgeons, and pulmonologists to provide conclusive services and tests as needed to help identify the cause of any swallowing disorder.
The UPMC Swallowing Disorders Center offers a variety of special services, including:
- Diagnostic tests
- Individualized treatment programs for swallowing difficulties brought on by neurologic diseases such as amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), Parkinson’s disease, and myasthenia gravis
- Head and neck cancer rehabilitation program
- Strengthening exercise programs
- Biofeedback treatment program
- Respiratory retraining
- Educational resources for patients, family members, and health care professionals
Our Experts
Click on the experts' names to read more about their specialties and backgrounds.
- Danielle Columbe, MA, CCC
- James L. Coyle, MA, CCC, BRS-S
- Bridget C. Hathaway, MD
- Jonas Johnson, MD
- Tamara Wasserman-Wincko, MS, CCC
- Alec Vaezi, MD
Conditions We Treat
An estimated 18 million Americans have discomfort or difficulty while swallowing. Dysphagia is the medical term that refers to difficult swallowing.
Some swallowing disorders are mild and can be readily treated. Others are more severe and/or progressive and require long-term rehabilitation or surgery. Even minor swallowing disorders may affect quality of life, thus requiring immediate attention. If dysphagia is overlooked, it may lead to severe consequences such as malnutrition, dehydration, or aspiration pneumonia (an infection that may result from food or liquid entering the lungs), chronic bronchitis, and pulmonary fibrosis.
Dysphagia and related nutrition problems are often seen in patients with:
- Cancers of the head and neck
- Side effects of treatments:
- Radiotherapy
- Combined chemo and radiation therapy
- Surgical changes to the anatomy
- Trauma to the head and neck
- Cerebrovascular accident (CVA or stroke)
- Chronic neurologic disorders:
- Amyotrophic lateral sclerosis (ALS, or Lou Gehrig’s disease)
- Parkinson’s disease
- Myasthenia gravis
- Multiple sclerosis (MS)
- Gastroesophageal reflux (GERD)
- Tracheostomy
- Dry mouth (xerostomia)
- Vocal cord paralysis
- Disorders related to aging:
- Loss of muscle mass
- Generalized weakness
- Deconditioning
- Dementia
- Autoimmune disorders:
- Scleroderma
- Myositis
- Rheumatoid arthritis
- Post-surgical swallowing disorders from:
- Thyroid surgery
- Cervical spine surgery
- Surgery to the mouth and throat
Understanding the Normal Swallow
Swallowing is life sustaining as well as important to social activity. We swallow 2,000 to 3,000 times every day. Swallowing is a very complex act requiring many muscles coordinated by the brain and brainstem. Swallowing takes place in four stages:
- Oral preparatory phase - This stage takes place in the mouth and involves biting and chewing. During this stage, food is broken down into smaller pieces and mixes with saliva. This preparation stage is where the pleasure of eating is derived.
- Oral phase - In this stage, the tongue pushes the food or liquid to the back of the mouth, where it is positioned to pass into the throat (pharynx). When this stage is completed, there should be no food or liquid remaining in the mouth.
- Pharyngeal phase - During this phase, the palate, the soft structure that hangs in the back of the throat, elevates to prevent food or liquid from entering the nose. The voice box closes to prevent food from entering the windpipe, and a muscle at the low end of the pharynx relaxes to allow food to enter the esophagus.
- Esophageal phase - A series of coordinated muscle contractions pushes the food down the esophagus (food tube) and into the stomach.
Swallowing and Nutrition Concerns During Radiation Therapy for Head and Neck Cancers
Swallowing
Nutrition
Our Services
Evaluation of Swallowing
The functional assessment of swallowing disorders includes one or several procedures that allow the examiners to view the mouth and throat during the process of swallowing. The tests include:
-
Modified barium swallow (MBS)
This x-ray of swallowing identifies problems that occur in the mouth, at the base of the tongue (back portion of the tongue located in the throat), in the pharynx (throat), larynx (voice box), trachea (wind pipe), lungs, or the esophagus. In addition, this study also provides information about tongue motion and coordination and timing of the swallow. This study is useful not only to identify your problem, but it also offers information that will guide treatment.
-
Fiberoptic endoscopic evaluation of swallowing (FEES)
The fiberoptic endoscopic evaluation of swallowing is a standard test using a small flexible fiberoptic endoscope, a small tube with a miniature camera and light on the end of it, to view your pharynx (throat) and larynx (voice box).
The inside of your nose is coated with an anesthetic gel to reduce the sensation of the endoscope being passed. The endoscope is passed through your nose to a position slightly above the voice box.
Once you are comfortable, you will be given foods or liquids that are tinted with food dye so the examiner can follow their passage. The examiner then watches the material as it passes from the base of the tongue into the esophagus (swallowing passageway). Careful observation is made of foods and liquids that are retained in various areas.
In addition, careful observation is made of any of the food substances that drip into the airway causing the patient to cough or choke. Important aspects such as the speed of the swallow, the amount of food or liquid that is not swallowed on the first swallow, and amounts of foods or liquids that drop near or into the airway can be observed under clear vision. At the same time, a recording of the entire examination is made so that the treatment team can view the results with you as often as necessary and offer a plan of treatment.
A FEES test is needed when you complain of a weak voice, you choke after eating or drinking, the food still feels like it is in your throat, or there is a significant change in your voice after swallowing. The entire test takes about five to six minutes once you are properly prepared.
-
Fiberoptic endoscopic evaluation of swallowing with sensory testing (FEEST)
This study is performed by an otolaryngologist and speech-language pathologist. A puff of air is used to test the protective reflexes of the larynx (voice box) as part of the FEES study.
-
Manometry
Manometry measures pressures from muscle force (strength) or bolus flow (food moving through the mouth and throat). Manometric pressures are used to measure the strength of swallowing muscles or to determine when swallowing muscles are too tight.
-
Manofluoroscopy
This is a combination of an MBS and manometry.
-
Transnasal esophagoscopy (TNE)
The TNE is a procedure in which the inside of the esophagus is examined by a long thin fiberoptic endoscope with a camera on it. The doctor can see the inside of the esophagus by watching a video monitor and determining whether any problems are present.
Nonsurgical Treatments of Swallowing Disorders
Swallowing rehabilitation involves the use of exercises, changes in diet, and changes in the neck and body posture to improve swallowing safety and efficiency. An individual treatment plan is developed for each patient because swallowing disorders vary in the degree of severity.
The goal of swallowing rehabilitation is to re-establish oral feeding to a level that is as normal as possible. The swallowing rehabilitation program begins after a detailed swallow evaluation has been completed. Treatment is then provided by a speech-language pathologist who specializes in the evaluation and treatment of swallowing disorders. The treatment plan may include:
- Oral motor exercises
- Swallowing maneuvers
- Postural techniques
- Diet modifications
- Nutrition counseling
- Voice strengthening exercises
Surgical Treatments for Swallowing Disorders
Surgery is usually a last resort reserved for patients with swallowing disorders that do not respond to swallowing therapy. Surgical procedures are customized to the patient's needs and, in general, are aimed at improving the patient's existing swallowing function as much as possible. These procedures can be categorized as follows:
- Procedures that improve the closure of different valves within the swallowing mechanism, such as the soft palate and vocal cords
- Surgeries used to open valves that are too tight, such as the upper esophageal sphincter, a “muscle-valve” between the throat (pharynx) and foodpipe (esophagus)
- Surgeries to correct mechanical obstruction, such as a narrowing, or tumors
- Surgeries that separate the esophagus from the airway
- Surgeries that can aid the patient in sustaining his or her weight and/or nutritional balance (gastrostomy tube placement)
Although the physicians of the Swallowing Disorders Center do not perform gastrostomies, if one is needed, they can refer you to an appropriate physician.
The most common surgeries recommended for patients with specific swallowing disorders include:
Medialization of the Vocal Cord
Medialization refers to the process of moving a paralyzed vocal cord closer to the middle, so that the other vocal cord can close the gap between them and protect the trachea (windpipe). Surgeons can use either of the following techniques to achieve this purpose.
-
Vocal fold (cord) injection
This is the least invasive technique, but it is less accurate than other procedures that involve traditional surgery (incision). The vocal cord can be injected with permanent and/or temporary materials to add bulk to the tissues of the vocal fold and/or move it closer to the middle. The injection can be done through the mouth or through the skin of the neck.
-
Laryngeal framework surgery
This type of surgery includes procedures in which an implant is used to add bulk and/or move the vocal cord closer to the middle. Some patients require placement of a stitch be placed at the joint of the vocal cord to correct the position of the joint. Although it involves an external incision, to create a window in the larynx (voicebox), the effect of this surgery is very reliable and the improvement is immediate.
Pharyngoesophageal Dilation
Stenosis of the pharynx and upper esophagus (narrowing of the throat) most commonly results from radiation therapy to the head and neck (with or without chemotherapy). Stenosis may also occur following surgery for tumors of the upper aerodigestive tract (voice box or food passage of the throat).
This narrowing may cause patients to experience difficulty swallowing solids and/or liquids. Pharyngoesophageal dilatation involves passing an inflatable balloon or bougie (long, flexible rubber cylinder) through the mouth into the throat to strech the narrowed area.
Cricopharyngeal Myotomy
The cricopharyngeus muscle is located at the level of the lower neck. This muscle works like a valve to prevent the swallowing of air when we breathe and to prevent food from coming back up into the throat after it has been swallowed into the esophagus.
The muscle is usually tight but relaxes to let food go down. In a variety of conditions, such as a spasm or achalasia, the muscle fails to relax, stopping the passage of food from the throat into the esophagus. In this case, the muscle may be cut to allow the free passage of food.
Surgery for Zenker's Diverticulum
A Zenker's viverticulum is an outpouching in the pharynx (throat) that develops due to failure of relaxation in the upper esophageal sphincter during swallowing. Food may collect in this outpouching causing regurgitation of food following meals or even aspiration (food spilling over from the pouch into the windpipe).
A Zenker's diverticulum may be treated by making an incision in the neck and either removing the pouch or securing the pouch so that it drains into the esophagus more effectively. During this "open approach," a cricopharyngeal myotomy (see above) is also usually performed.
Alternatively, many Zenker's diverticula are amendable with endoscopic surgical treatment (through the mouth, without incisions in the neck). The endoscopic procedure involves looking through the mouth with a telescope and dividing the common wall separating the pouch from the esophagus.
Palatopexy
A palatopexy is recommended for those patients whose soft palate is paralyzed, causing food to backflow into the nose. This procedure affixes the soft palate (the tissue that hangs at the back of the throat) to the back wall of the throat, using permanent stitches.
Laryngo-Tracheal Separation
In the extreme event in which a patient continues to aspirate (that is, food continues to go into the windpipe), leading to repeated pneumonias, the foodway (esophagus) can be completely separated from the airway (trachea or windpipe). This is a last resort, reserved for patients who have suffered catastrophic strokes and those presenting with advanced stages of neurologic diseases, such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or Parkinson’s disease.
Patient Information
It is important for patients to play an active role in their health care. Diagnosis starts with the patient recognizing possible swallowing disorder symptoms and contacting UPMC’s Swallowing Disorders Center if he or she experiences any symptoms.
It is also important for patients to understand the sequence of events for their first visit to the Swallowing Disorders Center. Knowledge is the first step toward recovery.
Recognizing Swallowing Disorders
There are several common symptoms of swallowing disorders that call for a person to schedule an appointment with UPMC’s Swallowing Disorders Center. If you experience any or several of these symptoms you should contact a doctor. These common symptoms of swallowing disorders include:
- Coughing or throat clearing upon swallowing food or saliva
- The sensation of food sticking in the throat
- Sensation of a lump in the throat
- Unexplained increase in bronchial secretion (phlegm)
- Wheezing or breathing difficulty when eating
- Loss of appetite or weight loss
- Unexplained bouts of pneumonia or bronchitis
- Drooling or loss of food from the mouth
- Heartburn or indigestion
- Food or liquid forced up through the nose
- Hoarseness or a “wet” or “gurgly” vocal quality after swallowing
- Difficulty chewing or swallowing certain food consistencies
- Regurgitation of food into the throat or nose
Your First Visit to the UPMC Swallowing Disorders Center
Most medical insurance plans, including Medicare, cover the cost of the initial examination and diagnostic testing. Depending on your insurance carrier, you may need a referral from your primary care physician (PCP). If necessary, you should obtain a referral form from your PCP and fax or send it to us.
On the Day of Your First Appointment
Your first visit will last between 45 minutes to 1½ hours.
For your appointment, bring copies of previous test results, examination records, or x-ray films that are relevant to your problem, or arrange with your primary care doctor's office to have this information sent to the Swallowing Disorders Center.
When you arrive, you will be asked to complete a patient history form and will speak with one of our staff members to review your medical history and swallowing problem.
A team consisting of an ear, nose, and throat physician (otolaryngologist) and a speech and language pathologist will determine if you need testing. If they determine that testing is needed, you will be moved to the examination room where a fiberoptic endoscopic evaluation of swallowing (FEES) test will be performed.
After Testing
After testing, the ear, nose, and throat doctor and/or speech language pathologist will review the results of the tests with you and provide you with a diagnosis and plan of treatment to return you to optimum eating and swallowing. This treatment program may include swallowing therapy, a nutrition evaluation, or other therapies.
After your initial visit, you will be scheduled for either a follow-up examination or for therapy. You also will receive any necessary referrals to other specialists or special tests such as the modified barium swallow. These tests can often be completed on the same day as the assessment. As a result, the cause of your swallowing problem is usually identified during your first visit to the center.
Nutrition Information
Foods to Avoid for Patients Being Treated for Head and Neck Cancer
While receiving radiation therapy for cancer of the head and neck, the following foods should be avoided:
- Products that contain caffeine such as coffee, tea, colas, and chocolate; caffeine can cause dehydration
- You may experience trouble swallowing the following:
- Dry meats, poultry, and fish without sauces
- Dry breads, rolls, pasta, rice, pretzels, chips, cereal
- Dried fruit or vegetables, unless prepared in a sauce or with a high moisture content
- Cookies, cake, and pie, unless soaked in milk
Recipes to Increase Your Caloric Intake
The following recipes may help to increase your caloric intake while you are receiving radiation therapy.
Double Strength Milk
- 8 ounces whole milk
- 5 tablespoons nonfat dry skim milk powder
- Mix ingredients. Chill and serve.
- Calories: 240
- Protein: 16 grams
Super Soup
- 6 ounces of a cream soup
- ½ jar (3 ½ ounces) strained meat
- Mix, heat, and serve.
- Calories: 135
- Protein: 9 grams
Fruit Juice Shake
- 1 cup vanilla ice cream
- 1 cup apricot nectar
- 2 teaspoons raspberry syrup
- Mix ingredients until smooth.
- Different juice and syrup combinations can be used.
- Serving: 15 ounces
- Calories: 430 per serving
- Protein: 7 grams
Yogurt Shake
- 1 container of banana yogurt
- 6 ounces of pineapple juice
- Blend, chill, and serve.
- Calories: 360
- Protein: 11 grams
Super Shake
- 24 ounces of whole milk
- 12 ounces of ice cream
- 1 cup nonfat instant milk powder
- Pour milk powder into a bowl. Melt ice cream to room temperature. Blend melted ice cream and whole milk into milk powder until smooth.
- Servings: four 8-ounce servings.
- Calories: 280 per serving
- Protein: 15 grams per serving
Orange Smoothie
- 1 ½ cups orange sherbet
- ½ cup whole milk
- 4 tablespoons dry skim milk powder
- Mix all ingredients in blender until smooth.
- Calories: 350
- Protein: 15 grams
Apple Salad
- 1 cup pineapple juice
- 1 cup Cool Whip
- 1 cup applesauce
- Puree in blender and serve.
- Calories: 480; good source of vitamin C.
Apricot Cream
- 1 12-oz. can apricot nectar
- 1 cup vanilla frozen yogurt
- Blend and serve.
- Makes two servings
- Calories: 160 each; excellent source of vitamins A and C, calcium, and potassium
Banana Shake
- 1 8-oz. glass milk
- ½ banana
- 2 teaspoons sugar
- ½ teaspoon vanilla
- Slice the banana into the blender and pour half of the milk over and puree. Add the rest of the milk and remaining ingredients and blend.
- Calories: 235; provides vitamin A, potassium, and calcium.
Chocolate-Peanut Delight
- 2 tablespoons creamy peanut butter
- 2 tablespoons chocolate syrup
- 2 scoops vanilla ice cream
- 1 cup milk
- Puree in blender.
- Calories: 860; provides vitamin A and protein.
Chocolate Banana Split
- 2 cups milk
- ¼ cup chocolate syrup
- 1 banana
- ½ cup Cool Whip
- Slice banana into blender. Use just enough milk to cover banana. Puree well. Add remaining ingredients and remainder of milk. Blend and serve.
- Calories: 975; provides calcium, protein, and potassium.
Cocoa
- 1 rounded teaspoon cocoa
- 2 rounded teaspoons sugar
- Splash of very hot water
- 1 cup milk
- Combine sugar and cocoa adding a splash of hot water to dissolve. Add milk and heat.
- Calories: 245; provides vitamin A and calcium.
Fruit Bowl Mix
1 can Mandarin oranges
1 15-ounce can crushed pineapple
- 1 small box vanilla instant pudding
- 2 large bananas, sliced
- 1 small jar maraschino cherries
- Drain fruit, reserving juice. Use ½ cup of juice from fruits to mix with pudding. Add fruit. Chill. Add sliced bananas before serving.
- Servings: 3
- Calories: 415 per serving; provides vitamin C and potassium.
Hawaiian Sunset
- 1 pint raspberry sherbet
- 1½ cups pineapple juice
- 1½ cups ginger ale
- Combine all in a blender and serve.
- Servings: 2
- Calories: 405 per serving; provides vitamins A and C, and calcium.
Orange Julius
- ½ can (6 oz.) frozen orange juice
- ½ cup milk
- ½ cup water
- ¼ cup sugar
- ½ teaspoon vanilla
- 1 scoop vanilla ice cream
- Liquefy in blender for 30 seconds
- Servings: 3
- Calories: 213 per serving
Soothing Fruit Drink (A refreshing beverage for a sore mouth)
- 6 ounces pear nectar
- 1 ounce cherry Kool-Aid
- 1 ounce apricot nectar
- Combine all ingredients.
- Calories: 140
- Protein: Less than 1 gram
- Calcium: 10 milligrams
Cranberry Fizz
- ½ cup cranberry juice cocktail
- ½ cup ginger ale
- 2 tablespoons orange juice
- Mix all ingredients together.
- Calories: 170
- Protein: less than 1 gram, 19 milligrams calcium
Frozen Yogurt on a Stick
- 1 6- to 8-ounce container of flavored yogurt
- Cut a small slit in the top. Place a wooden Popsicle stick through the slit into the yogurt. Freeze yogurt. When fully frozen, peel off wrapping and enjoy.
- Calories: 170-230
- Protein: 6 to 10 grams
- Calcium: 345 milligrams
Apple Pie a La Mode
- 1 cup apple pie filling
- 1 cup vanilla ice cream
- ½ cup milk
- Dash cinnamon
- Mix all ingredients together.
- Calories: 413
- Protein: 9 grams
- Fat: 19 grams
Peach Smoothie
- 1 ½ cup canned and drained peaches
- 1 cup whole milk
- ½ cup ice
- ¼ cup sugar
- Mix all ingredients together.
- Calories: 420
- Protein: 9 grams
- Fat: 8 grams
Great Grape Slush
- 2 grape juice bars
- ½ cup grape juice or 7UP
- 2 tablespoons corn syrup
- Mix all ingredients together.
- Calories: 490
Turkey and Dressing
- 3 ounces of turkey
- ½ cup dressing
- ½ cup mashed potatoes
- 1 cup gravy
- ¾ cup bouillon or hot water
- Blend turkey, dressing, and potato until smooth. Add gravy and liquid. Blend. Strain. Thin with additional liquid if necessary. (Try other main dishes in this manner).
Meat Patties
- 1 jar junior lamb, beef, veal, pork, or chicken
- ½ cup mashed potatoes, seasoned to taste
- Butter a small individual casserole. Place half of the mashed potatoes in bottom of the casserole. Top with junior meat. Spoon remaining mashed potatoes in mounds around the edge of the casserole leaving a little of meat showing. Bake at 375° F until top is lightly browned.
Tuna Fish Casserole
- 2 jars strained peas
- ½ (7-oz can) tuna fish
- 2 jars strained vegetables and chicken
- Bread crumbs
- ¼ cup of any baby cereal
- Salt
- Margarine
- Combine strained peas, flaked tuna fish, strained vegetables, and chicken. Add cereal and salt to taste. Place in casserole or individual baking dishes; top with breadcrumbs and dot with margarine. Bake at 375°F until firm.
Extra Rich Pudding
- ¾ cup whole milk
- 1 cup vanilla ice cream
- 1 package (4 serving size) instant pudding (any flavor)
- 2 Tbs. dry skim milk
- Soften ice cream. Mix dry skim milk with whole milk. Thoroughly blend milk and ice cream in a bowl. Add pudding mix and beat slowly with rotary beater or at low speed of electric mixer until blended, about one minute. Pour into cups and chill until set (about three hours).
- Servings: 4
- Calories: 279
- Protein: 5 grams
Swallowing FAQs
What are the side effects of radiation therapy for the treatment of head and neck cancer, and will these side effects change my swallowing?
There are immediate and long-term effects of radiation therapy for the treatment of head and neck cancer. The immediate effects may include dry mouth, burning sensations, sore throat, sore tongue or lips, ulcerations, difficulty with denture retention, and abnormal taste and smell.
Whether you develop cavities in your teeth will depend on your oral hygiene. A build-up of plaque on your teeth can occur due to the altered flow of saliva. Fluoride treatments are recommended to prevent tooth decay.
The long-term effects may include limited ability to open the mouth (trismus), fibrosis (excess tissue formation), dead tissue (soft-tissue necrosis), and swelling.
These side effects can alter swallowing function depending on how much therapy you receive and which area receives the radiation. Patients usually have the most difficulty during the course of treatment and need to make changes in their diet to prevent swallowing discomfort.
After radiation therapy, patients appear to be more interested in trying to eat different kinds of foods again, but they may need to be re-evaluated to determine what foods are the safest to swallow.
Do I need to have a specialist check my swallowing when I begin radiation therapy?
It is very helpful to have swallowing tests before and after radiation therapy to note any changes that have occurred. These tests will provide your doctor with information that will direct the most appropriate treatment plan to help you achieve your swallowing and nutrition goals.
A fiberoptic endoscopic evaluation of swallowing (FEES) is a swallow test that involves the use of a small camera to view the structures of the throat during swallowing. Undergoing this examination before radiation begins will allow your doctor to compare the changes that occur after treatment, and it will help to determine what kinds of foods and liquids are the safest and most manageable for you during treatment.
Swallowing exercises will be recommended after the initial evaluation. It is important to exercise the muscles used in swallowing both during and after treatment to prevent scar tissue from developing.
What can I expect when I go through radiation therapy?
You may start to notice one to two weeks into your treatment that your mouth is dry. By the third week of your treatment, you may start to notice that certain foods are more difficult to swallow.
Most people need to change the types of foods they eat because of ulcerations in the mouth. These ulcerations can cause burning sensations, especially when they come in contact with spicy or acidic foods and drinks.
Your taste buds also are radiated at the time of your treatment, since they are in the treatment area. They become inactive during this period, so your taste may change, and you won’t recognize some flavors. However, in about three months, you should start regaining some taste. You might want to marinate meats in fruits, sauces, or soy sauce to add flavor.
Will the radiation do anything to my teeth?
As a result of the radiation therapy, saliva production may decrease and the consistency of the saliva in your mouth may change. Saliva protects your teeth from bacteria, so these changes may make your teeth more susceptible to bacterial attack.
You also may be eating more foods that have a higher sugar content to maintain your weight. Because the excess sugar will attract bacteria that can cause tooth decay, it is very important for you to clean your mouth well, especially before and after you eat. You may also want to use an alcohol-free mouthwash such as Biotene.
If your mouth is the area being treated with radiation, you should see your dentist regularly, even if you wear dentures. Do not wear your dentures while undergoing therapy.
Will I develop a sore throat?
A sore throat is the main side effect of radiation therapy for head and neck cancers, but each patient will react differently depending upon the dose of radiation received.
What should I do for a sore throat?
Gargle with a mixture of one teaspoon of salt and one teaspoon of sodium bicarbonate (baking soda) in a quart of water six to eight times a day or more, and before and after each meal.
What can I do about dry mouth?
Frequently drink small amounts of water or juice or a high-calorie supplement such as Boost or Ensure. There is no limit to the amount of liquid you can consume while you are having radiation therapy.
Keep a glass of water or juice at your bedside to drink during the night if you need it. Include more moist foods in your meals such as gravies, sauces, sour cream, and macaroni and cheese. Add extra butter to help lubricate your mouth and increase your calories.
Chew ice chips or sugarless gum, drink ginger ale, or use an artificial saliva formula to increase moisture in your mouth, especially immediately before eating.
If your saliva is thick, try sipping pure papaya juice. Papaya contains natural substances that will help thin the thick saliva. There are artificial saliva substitutes that may relieve the dryness. Check with your doctor. Some artificial saliva substitutes have side effects such as excessive sweating and diarrhea.
Some days swallowing seems to be more difficult than others. Is this normal?
This is normal because you may have more swelling some days than others. Increased swelling will make swallowing more difficult. If you consistently notice that it is more difficult to swallow, call your doctor.
Should I continue to try to swallow things that I can manage, even if I have a feeding tube in place?
Continue to use the muscles involved in swallowing as much as possible. If you are able to swallow water safely, then it is important to continue. Water may help relieve some of the dryness in your mouth and throat. If you do nothing at all, those muscles may tighten more, causing swallowing to be even more difficult when you complete radiation therapy.
I have noticed that my swallowing is becoming worse now that my radiation therapy has ended. What should I do?
You may be experiencing some of the late effects of radiation treatment, which may include a tightening sensation due to swelling and a narrowing of the passageway where food travels (esophagus). You should consult your doctor for further recommendations. Sometimes this area can be stretched by a procedure called dilatation.
Nutrition FAQs
What are the goals of nutrition during radiation therapy for head and neck cancers?
Nutrition during radiation therapy should help the patient feel better, retain their strength and energy, maintain their normal weight and the body’s nutrition stores, decrease the risk of infection, and help the patient to tolerate treatment-related side effects, and to recover as quickly as possible.
During the course of radiation therapy, will I be able to eat the same kinds of foods that I normally eat?
It will depend on the area of the head and/or neck that is receiving treatment and the amount and frequency of radiation you are receiving. Usually, the side effects of radiation prevent patients from eating a regular diet.
A bland diet is often recommended. If you are undergoing chemotherapy along with radiation therapy, you may experience a loss of appetite. Most people seem to drink more liquids and eat less solid food during radiation therapy. If this occurs, an evaluation by a registered dietitian is recommended.
Why am I constipated, and what can I do about it?
Emotions, pain medication, and the lack of bulk in your diet — any or all of these may cause constipation. Your lower intestine needs bulk in order to function properly. If you have not been eating or drinking enough, it is possible that stool will not form in your lower intestine for two or three days.
This is normal. The following suggestions may help:
- Try to relax.
- Engage in light daily exercise. Even a brisk walk is helpful for normal bowel function.
- Eat meals regularly and slowly, and chew your food well.
- Eat cooked carrots, bananas and other fruits and vegetables. Before breakfas drink juices (prune juice) or a glass of warm water with a teaspoon of lemon juice added.
- Drink plenty of fluids.
Why can't I taste the food that I eat?
Your taste buds also are radiated at the time of your treatment since they are in the treatment area. They become inactive during this period, so your taste may change, and you won’t recognize some flavors. However, in about three months you should start regaining some taste. You might want to marinate meats in fruits, sauces, or soy sauce to add flavor.
What if I don’t feel like eating?
It is very normal for appetite to decrease during treatment. Your regular routine of daily living has changed, and there are a lot of new things to get used to, including your taste for food and ability to eat. You may also feel tired, which can decrease your desire to eat and to enjoy food.
Make an effort to keep mealtime pleasant. Remember that eating well is one of your most important medicines. Try to “eat with your eyes.” At mealtime, stimulate your appetite with a nice table setting, pleasant colors, favorite aromas, and a peaceful atmosphere.
The following tips also may help to stimulate your appetite:
- Walk or participate in another light activity.
- Eat small, frequent meals and snacks.
- Make food preparation an easy task by choosing foods that are easy to prepare and eat.
- Select high-protein and high-calorie snacks.
- Drink a nutritional supplement to provide additional calories, protein, and other nutrients. A registered dietitian can recommend a good brand to meet your needs.
- Avoid beverages with no nutritional value such as black coffee and tea.
- Plan meals to include your favorite foods.
- Make eating a pleasurable experience, not a chore. Liven up your meals by using colorful place settings. Play background music during meals.
- Try not to eat alone. Invite a guest to share your meal or go out to dinner.
- Use your imagination to increase the variety of food you're eating.
- Use colorful garnishes such as parsley and red or yellow peppers to make food look more appealing and appetizing.
Will I need a feeding tube during my treatment?
Most likely, yes. A sore throat is the main side effect of radiation therapy for head and neck cancers. If your sore throat is severe, you may be unable to take in enough food and liquids by mouth to maintain your weight or avoid dehydration.
Your doctor will place a feeding tube temporarily into your stomach (a gastrostomy tube), which will allow you to maintain adequate nutrition without having to swallow all of the food that you need.
It is important to continue swallowing even with a gastrostomy tube in place. Otherwise, your swallowing muscles may atrophy, causing permanent swallowing problems and making it difficult to stop using the gastrostomy tube even after the course of radiation treatment is completed.
How should I wean myself from the feeding tube?
Try keeping a food record of everything you eat and drink. The time period varies greatly from one patient to the next. In addition to safety and nutrition factors, a patient's medical status plays a huge role. The ultimate goal of swallowing therapy is to have every patient fed orally. Feedings by mouth should be safe and adequate to maintain nutrition and hydration.