The development of communication and listening is easily disrupted because of ENT disease or abnormality. The child's relationship with both the ENT specialist and the speech-language pathologist is critical, and may need to span several years, because communication difficulties may persist after any apparent physical problems resolve. Jointly-considered timing for surgical and speech intervention keeps services well-targeted and cost-effective.1
Clinical management of hearing impairment typically involves a combination of hearing aids, cochlear or brainstem implants, signal-to-noise improvement in educational settings, and speech therapy.2 For children with cochlear implant, auditory habilitation intervention is associated with markedly improved outcomes.3 For adults as well, person-centered management of postlingually deafened individuals with cochlear implants can be augmented by a more complete approach utilizing the skill set of a speech-language pathologist.4
Children with dysphonia are best handled by a team of specialists in pediatric otolaryngology and speech-language pathology with expertise in voice and resonance disorders. Voice teams use a variety of assessment tools, including perceptual, parent- and patient-based, instrumental, and imaging measures.5 Because behavioral evaluation and treatment of dysphonia is the interdisciplinary responsibility of the speech-language pathologist as well.6
In ankyloglossia and velopharyngeal dysfunction, if amenable to surgical intervention, it is important for experienced speech language pathologists to be involved, principally to diagnose the related speech disorder, and to optimize speech outcomes.7
The literature supports behavioral treatment provided by a speech-language pathologist in treating idiopathic conditions like exercise-induced laryngeal obstruction, with paced exercise, and use of breathing techniques to optimize laryngeal aperture,8 and globus sensation, a condition accounting for about 4% of new referrals to ENT clinics,9 and poor glottal gap closure, for which meta-analysis supports the clear efficacy of voice therapy intervention.10 Another vexing condition is objective chronic cough, that persists despite comprehensive medical management. For these particular patients, there is a range of evaluation and interventional therapy speech-language pathologists as well.11
Oromyofunctional speech-language pathologist are vital to patients’ recovery and rehabilitation following surgery, such as for adenotonsillectomy,12 treatment for vocal nodules,13 cleft palate repair (particularly with regard to monitoring for obstructive sleep apnea), and of course cancer of the head and neck.14 Dysphagia is a significant complication of cancer treatment in particular, due to neuromuscular and sensory damage to the swallowing mechanism.15 Post-treatment dysphonia and dysphagia are also common, and diverse in presentation. With the help of voice and swallowing therapy, many patients return to functional communication and oral feeding.16,17
1 Gardner H. Collaborative working between pediatric speech and language therapy and ENT colleagues: what is good practice? Curr Opin Otolaryngol Head Neck Surg. 2014 Jun;22(3):167-71. doi: 10.1097/MOO.0000000000000057.
2 Wrobel C, Zafeiriou MP, Moser T. Understanding and treating paediatric hearing impairment. EBioMedicine. 2021 Jan;63:103171. doi: 10.1016/j.ebiom.2020.103171.
3 Percy-Smith L, Tønning TL, Josvassen JL, Mikkelsen JH, Nissen L, Dieleman E, Hallstrøm M, Cayé-Thomasen P. Auditory verbal habilitation is associated with improved outcome for children with cochlear implant. Cochlear Implants Int. 2018 Jan;19(1):38-45. doi: 10.1080/14670100.2017.1389020.
4 Ray C, Taylor E, Vasil KJ, Zombek L, Baxter JH, Moberly AC. The Value of Speech-Language Pathologists in Auditory Rehabilitation for Adults With Cochlear Implants. Am J Speech Lang Pathol. 2021 Jul 14;30(4):1909-1911. doi: 10.1044/2021_AJSLP-20-00189.
5 Smith ME. Care of the child's voice: a pediatric otolaryngologist's perspective. Semin Speech Lang. 2013 May;34(2):63-70. doi: 10.1055/s-0033-1342977.
6 Schneider SL, Sataloff RT. Voice therapy for the professional voice. Otolaryngol Clin North Am. 2007 Oct;40(5):1133-49, ix. doi: 10.1016/j.otc.2007.05.013.
7 Shen T, Sie KC. Surgical speech disorders. Facial Plast Surg Clin North Am. 2014 Nov;22(4):593-609. doi: 10.1016/j.fsc.2014.07.010.
8 Shaffer M, Litts JK, Nauman E, Haines J. Speech-Language Pathology as a Primary Treatment for Exercise-Induced Laryngeal Obstruction. Immunol Allergy Clin North Am. 2018 May;38(2):293-302. doi: 10.1016/j.iac.2018.01.003.
9 Khalil HS, Bridger MW, Hilton-Pierce M, Vincent J. The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial. Rev Laryngol Otol Rhinol (Bord). 2003;124(3):187-90.
10 Alegria R, Vaz Freitas S, Manso MC. Efficacy of speech language therapy intervention in unilateral vocal fold paralysis - a systematic review and a meta-analysis of visual-perceptual outcome measures. Logoped Phoniatr Vocol. 2021 Jul;46(2):86-98. doi: 10.1080/14015439.2020.1762730.
11 Soni RS, Ebersole B, Jamal N. Treatment of Chronic Cough. Otolaryngol Head Neck Surg. 2017 Jan;156(1):103-108. doi: 10.1177/0194599816675299.
12 Donnelly MJ. Hypernasality following adenoid removal. Ir J Med Sci. 1994 May;163(5):225-7. doi: 10.1007/BF02943255.
13 Iqbal M, Mumtaz N, Saqulain G, Iftikhar N. Paediatric vocal fold nodules: management strategies to restore normal phonation-Speech-Language Pathologists perspective: A cross-sectional survey. J Pak Med Assoc. 2022 Jul;72(7):1414-1417. doi: 10.47391/JPMA.4236.
14 Jung K, Narwal M, Min SY, Keam B, Kang H. Squamous cell carcinoma of head and neck: what internists should know. Korean J Intern Med. 2020 Sep;35(5):1031-1044. doi: 10.3904/kjim.2020.078.
15 Manikantan K, Khode S, Sayed SI, Roe J, Nutting CM, Rhys-Evans P, Harrington KJ, Kazi R. Dysphagia in head and neck cancer. Cancer Treat Rev. 2009 Dec;35(8):724-32. doi: 10.1016/j.ctrv.2009.08.008.
16 Samlan RA, Webster KT. Swallowing and speech therapy after definitive treatment for laryngeal cancer. Otolaryngol Clin North Am. 2002 Oct;35(5):1115-33. doi: 10.1016/s0030-6665(02)00033-6.
17 Ringash J, Bernstein LJ, Devins G, Dunphy C, Giuliani M, Martino R, McEwen S. Head and Neck Cancer Survivorship: Learning the Needs, Meeting the Needs. Semin Radiat Oncol. 2018 Jan;28(1):64-74. doi: 10.1016/j.semradonc.2017.08.008.
MyoNews from BreatheWorksTM is a report on trends and developments in oromyofunctional disorder and therapy. These updates are not intended as diagnosis, treatment, cure or prevention of any disease or syndrome.