Head and Neck Cancer

Swallowing Problems

Swallowing requires movement of the lips, tongue, palate (roof of the mouth), throat, larynx (voice box) and esophagus (the long tube that connects the mouth and stomach). If one or more of these organs is not working due to surgery or radiation therapy, swallowing problems may occur. There are many different types of swallowing problems.

Surgery to the lip, tongue or jaw may cause food or fluids to fall from the mouth while chewing.
Changes in the palate (roof of the mouth) may result in the escape of air or food through the nose.
Changes in the pharynx (throat) may cause difficulty swallowing, and food may go into the lungs (aspiration) and cause pneumonia.
After a laryngectomy for cancer of the larynx (voice box), it may be difficult to move food from the mouth to the esophagus.
Radiation therapy to the head and neck and can lead to soreness in the mouth and throat, reduced saliva, dry mouth, and restricted movements of the muscles of the face, neck and throat.

Signs of Swallowing Problems

Swallowing many times to clear food from the mouth and throat
Gurgling or wet-sounding voice after swallowing
Coughing or choking
The need to clear throat while eating
Pain and dryness when swallowing
Aspiration of saliva or food into the trachea (windpipe) or lungs during swallowing

If these problems make it difficult to chew and swallow, you may be eating less. But even with these difficulties, it is important that you continue to swallow throughout your treatment. Just as it is said about other muscles, "use it or lose it", this advice applies to the muscles of swallowing.

Hints to Manage Swallowing Problems

Take food in small pieces and chew thoroughly, or puree food.
Moisten food with gravies, sauces, broth or mild to make it easier to chew or swallow.
Sip liquids between bites of food.
Try soft foods that are easier to swallow, such as gelatin, yogurt, pudding, pasta, overly cooked vegetables, canned fruit, soft cooked eggs, applesauce, cooked cereal, cottage cheese, ice cream and sherbert.
Allow foods to cool to room temperature.
Avoid nuts, crackers, dry cereal, raw fruits and vegetables, and other rough or dry foods if they hurt your throat and esophagus.
Take prescribed pain medication 30 minutes to one hour before you eat.

If you are losing weight because you are unable to eat normally, a dietitian, nurse, or your doctor may recommend liquid supplements or the use of a feeding tube.

Drink six to eight glasses of fluids a day unless you have been told not to eat or drink. This will help to prevent dehydration.

Swallowing Pills

If you have trouble swallowing pills, ask your nurse, doctor or pharmacist if you can crush the pills and take them with a teaspoon of ice cream, applesauce, or other soft food. Please note, it is important to consult with your health care provider because some medications cannot be crushed and taken safely. Check to see if the medication comes in liquid form.

Speech-Language Pathologist

You may see a Speech-Language Pathologist (SLP), a specialist in speech and swallowing problems. The SLP will discuss possible changes in speech and swallowing, evaluate you for the swallowing problems, and recommend an appropriate diet.

The SLP can provide therapy to improve your swallowing function, which may include:
Muscle exercises
Changing your diet to different textures to help you swallow easier
Ways to overcome chewing and swallowing problems
Head postures, such as chin tucks or turning your head to one side, to help you swallow safely
Ways to address issues such as dry mouth and decreased taste

This information originally appeared in the Journey Guide Patient Handbook developed by the Ireland Cancer Center at University Hospitals, and was adapted for use on NetWellness with permission, 2007.

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Last Reviewed: Apr 16, 2007

Jane Prasse, MA
Supervisor, Speech-Language Pathology
Head and Neck Surgery and Oncology
Ireland Cancer Center
University Hospitals
School of Medicine
Case Western Reserve University

Pierre Lavertu, MD, FRCS(C), FACS
Director and Professor
Head and Neck Surgery and Oncology
Ireland Cancer Center
University Hospitals
School of Medicine
Case Western Reserve University