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Clinical Resources

ADVANCE is pleased to offer clinicians patient handouts covering a variety of conditions. Clinicians are encouraged to distribute these resources to patients to help explain a medical condition. However, the resources are general guides only and patients should always consult a speech-language pathologist or audiologist with any further questions

Alaryngeal Speech

The speech-language pathologist's goal after a laryngectomy is to re-establish effective, efficient and functional communication. One of the techniques designed to help with post-surgical voice restoration is tracheoesophageal puncture (TEP). While not all laryngectomees are candidates for this procedure, it provides individuals with an option for alaryngeal speech that is more natural sounding and less labor-intensive than esophageal voice. [ADVANCE 16(30): 6-8]

Pierre Robin Sequence

Infants with Pierre Robin sequence are born with a combination of anomalies that often affect respiration, sleep, weight gain, growth and feeding. Feeding challenges can be due to the effect of the tongue and jaw on oral-motor movement, swallowing difficulties, and the effect of feeding effort on a compromised respiratory system. [ADVANCE 17(10): 6-8, 42].

Central Nervous System Plasticity

Research on the central auditory system has indicated that neural patterns and the way sound is encoded vary according to age. These findings may explain why two people with similar hearing loss and hearing aids may have different outcomes. [ADVANCE, 15(25):6-8]

The Aging Swallow

The natural aging process affects each stage of swallowing - oral, pharyngeal and esophageal. Transit time is prolonged in the oral stage and elderly patients with dental challenges may face additional feeding and swallowing issues during mealtime. Sarcopenia, the age-related loss of muscle mass, causes physiological changes in tongue muscles due to an increase in fatty tissue and a decrease in muscle fibers. [ADVANCE, 16(15):6-9]

Acoustic Neuromas

Also called vestibular schwannomas, these slow-growing benign tumors typically originate on the vestibular portion of the eighth cranial nerve. As the tumor grows, often within the internal auditory canal (IAC), it can impinge on the cochlear nerve, the vestibular nerve, the superior and inferior vestibular nerves, and the facial nerve. In most cases, the best treatment is surgical removal, which requires intraoperative monitoring by an audiologist.

Vocal Cord Nodules

Treatment for benign mucosal lesions of the vocal folds traditionally has consisted of two modalities: voice therapy and surgery. Among specialists, voice therapy is the treatment of choice for vocal fold nodules.


Swallowing disorders can be assessed using modified barium swallow (MBS) studies and videofluoroscopy.


Patients who present with voice problems due to an immobile vocal fold or cyst, nodule or polyp on their vocal fold may benefit from surgical treatments such as medialization laryngoplasty and microlaryngeal surgery. Speech-language pathologists provide voice therapy prior to and following these surgical procedures to address the individual needs of patients.

Cochlear Implants

Cochlear implantation is a viable treatment for severe to profound hearing loss in the elderly population. It is well tolerated and provides marked improvement in auditory performance.

Pediatric Dysphagia

When children present with swallowing and feeding problems, speech-language pathologists provide treatment to ensure safe and adequate swallowing, nutrition and weight gain.

Pre-Operative Laryngectomy Preparation for Post-Operative Care

Patients who are about to undergo a laryngectomy may become overwhelmed by the physical changes the surgery will cause, but speech-language pathologists can address many post-operative issues before the surgery by meeting with the patient for counseling. Patients must be trained in proper stoma care and hygiene and need to adjust to an immediate change in their ability to smell, which will be compromised or lost. They also need to be prepared to adjust to coughing out of the neck instead of the mouth and to expect secretions from the stoma. [ADVANCE 17(2): 6-9]

Laryngeal Cancer

Changes in the treatment of advanced laryngeal cancer have necessitated a closer look at the rehabilitation process of patients who undergo laryngectomy or laryngopharyngectomy, with a particular focus on the swallowing abilities of each population. Until recently, treatment for advanced laryngeal cancer almost always included a surgical intervention such as laryngectomy. Today, patients may have the option of chemoradiation. [ADVANCE 17(14): 6-8, 42]

Orofacial Myology

If not addressed immediately, orofacial myofunctional disorders such as digit-sucking, tongue thrust and habitual oral breathing, can result in years of costly orthodontic treatment and other long-lasting hardships. Orofacial myofunctional therapy gives speech-language pathologists a different point of view on misarticulation problems. School clinicians may find the identification of myofunctional disorders especially helpful since they are limited in what they can do to address the issues that are at the base of misarticulation. [ADVANCE, 16(4): 6-8, 50]

Pediatric Dysphagia

Babies with swallowing disorders have very low muscle tone and do not have the strength and coordination to get food down. They have to learn to coordinate sucking, swallowing and breathing. Babies born prematurely who have difficulty with this coordination need to be placed on a temporary feeding tube to initially get enough nutrition and prevent aspiration and subsequent pneumonia. Factors that may affect swallowing ability include growth in the facial structure, hospitalizations, bed changes, major surgeries, medication changes and major life events.

Head and Neck Cancer

Dysphagia, speech problems and aspiration can result from treatment for head and neck cancer, including surgery and radiation. Speech-language pathologists counsel patients prior to treatment to discuss anticipated changes in speech and swallowing and provide therapy afterwards to teach swallowing maneuvers and exercises and improve tongue-based retraction and laryngeal elevation.


Special precautions are needed when treating dysphagia in special populations including patients with dementia, tracheotomy and ventilator dependence. Patients with tracheotomy still require external support and/or management such as suctioning to achieve stability. Infection, hydration status, medications and arousal can dramatically affect patients' secretions and, subsequently, their respiratory and pulmonary status and stability.

Cochlear Implants

Although cochlear implants can't restore natural hearing, they enable children to enjoy significant gains in sound awareness and speech understanding.


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