• Reference Number: HEY1257/2021
• Departments: Speech and Language
• Last Updated: 21 October 2021

Introduction

This leaflet has been produced to give you general information about your condition.  Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and the healthcare team, but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What to be aware of?

Following your anterior cervical surgery, you may experience some swallowing or voice changes. This could be due to stretching of the nerves which supply the vocal cords during surgery, or as a result of post-operative swelling or bruising. You may find that eating food is more difficult due to this swelling or feel a ‘lump’ sensation in the throat. In the majority of cases, this does improve and recovers fully.  However, some people will continue to have persistent swallowing or voice problems which will need support from a Speech and Language Therapist.

If you experience these problems a doctor or nurse will refer you to Speech and Language Therapy (SaLT).

What happens next?

A Speech and Language Therapist will assess your swallow and your voice quality post-surgery. They will then make recommendations to ensure that you are able to swallow food and drink safely and help you to look after your voice.

Whether or not these symptoms last a short time or are long-standing, early assessment of your swallowing by a Speech and Language Therapist is important.  This is to reduce or eliminate the risk of aspiration (food going down the ‘wrong way’) and choking.

Voice symptoms and advice before and after anterior cervical surgery

Possible voice symptoms:

 Vocal fatigue

• Dysphonia ‘disordered voice’
  • Hoarseness or rough voice quality
  • Breathy or whispery voice quality
  • Strained voice quality
  • Weak voice or difficulties projecting your voice
• In some cases, ‘aphonia’ may occur – this is complete voice loss
• Dry throat
• Achy throat
• Globus sensation or ‘lump in the throat’

Advice

Before surgery:

Stop smoking as this may increase the risk of experiencing voice change. If you need support with this, contact Smoking Cessation services, e.g. NHS SmokeFree, NHS Quit Smoking App or ask staff to signpost or refer you.

• Inform family, friends and work colleagues that you may experience some voice difficulties after your surgery. Therefore, you can arrange the appropriate support and modify your environment in anticipation of your surgery.
• Bring a pen and paper into hospital with you so you can use this whilst you rest your voice post-surgery for 1 – 2 days.
• On the weeks leading up to surgery it is helpful to avoid unhealthy foods and drinks that may aggravate reflux such as alcohol and fried foods.

Immediately after surgery:

• Rest your voice – reduce the amount that you are talking, allow voice rest after using your voice.
• It is advised that you do not smoke.
• Whilst you are in hospital limit your vocal use as much as possible.
• Do not whisper or shout. This can aggravate the voice.
• Aim to use non-verbal communication like texting, emailing, writing things down, gesture.
• Be aware that lifting heavy objects increases pressure in the vocal folds. Encourage family and friends to support you such as getting them to carry your bags out of hospital.  Similarly, be aware that bearing down forcefully (such as when going to the toilet) can create increased tension and pressure in the voice box.
• Avoid harsh throat clearing or harsh coughing. (Please note that if you feel that you are throat clearing/coughing on your saliva, fluids or food please inform a member of staff immediately.)
• Our voice box needs to be moist to function well. Once you are eating and drinking safely it is important to maintain excellent hydration for optimal voice quality. Avoid caffeinated drinks that may dry you out such as tea and coffee (unless advised to have these by another healthcare professional).

One-two weeks after surgery:

 It is advised that you do not smoke.

• If you experience voice change, it may impact certain activities such as struggling to use the telephone and difficulties projecting your voice.
• It is helpful to have support at hand to delegate vocal tasks or temporarily reduce voice use. If necessary, have some time off work whilst your voice recovers.
• Make good use of non-verbal communication, such as texting and emailing instead of phone calls.
• Gradually increase the amount that you use your voice. Do not be tempted to raise your voice, shout or whisper. All of these place a greater demand on the voice box.
• Continue to avoid heavy lifting or bearing down forcefully. As before, encourage family and friends to support you.
• If you are eating and drinking normally make sure you are keeping well hydrated.
• Do not be tempted to throat clear if your throat is dry and tickly. Instead try sipping fluid, swallowing, or sniffing through your nose and blowing out through pursed lips.
• If you experience heartburn or have other reflux symptoms ask your doctor for advice as reflux can exacerbate voice problems.
• If your voice problems are severe or persistent you may need to be seen by an Ear Nose and Throat doctor who will examine your voice box.

Swallowing symptoms and advice after anterior cervical surgery

You may experience other symptoms not listed here especially if you have any pre-existing swallowing concerns or an existing neurological condition.

• Feeling of food, drink sticking
• Feeling of food, drink, saliva going down the ‘wrong way’
• Coughing, throat clearing when eating or drinking
• Choking when eating and drinking
• Pain on swallowing
• Having to take sips of fluid between mouthfuls to clear food residue
• Fatigue, tiredness when eating and drinking
• Problems coordinating breathing and swallowing
• Weight loss
• Chest infection

Advice

 If you experience swallowing concerns following surgery you will need to be assessed by the Speech & Language Therapist. However, there are some basic safe swallowing tips that all patients are advised to follow after Anterior Cervical Surgery:

1. Reduce distractions when eating and drinking
2. Eat, drink, take medications in an upright position, ideally sat out in a chair
3. Steady, slow eating and drinking rate – do not rush, take single sips of fluid avoid using straws or spouted beakers unless absolutely necessary
4. Take small bites
5. Chew your food very well
6. Do not talk whilst you are eating
7. Avoid difficult dry, chewy textures initially you may be advised to have softer moist foods after surgery.

If the swallowing problems are severe or persistent it may require you to have modifications to the texture of your food and the thickness of your fluids. Some people require alternative ways of eating and drinking such as having their nutrition and hydration through a tube that goes from their nose to their stomach. This is called a nasogastric tube, ‘NG tube’. For these people they may require longer periods of being nil by mouth ‘NBM’.

Should you require any further advice on the issues contained in this leaflet, please do not hesitate to contact the Speech and Language Therapy Department (01482) 604331