Voice, Speech & Swallowing Therapy
Enhancing your ability to communicate, swallow and breathe
Expert Help for Speech Conditions and Swallowing Problems
Speech, language and swallowing therapy at Beth Israel Deaconess Medical Center (BIDMC) is part of Rehabilitation Services. It may be part of your care if you have trouble communicating, upper airway disorders or swallowing problems that make it hard to safely eat or drink.
Our caring speech-language pathologists (SLPs) are nationally recognized in voice, speech and swallowing therapy. They work with other BIDMC specialists, including ear, nose and throat (ENT) doctors. Together, they diagnose your condition. Then, they develop a personalized treatment plan for you. Using state-of-the-art technology and advanced therapies, they can help you recover from an illness or medical condition and live life more fully.
Symptoms We Treat
If you don't yet have a diagnosis, an ear, nose and throat doctor who specializes in laryngology (disorders of the larynx, or voice box) can help. If you are experiencing any of the following symptoms, you should bring them to your doctor's attention:
- Chronic cough
- Coughing or choking while eating or drinking
- Difficulty breathing
- Difficulty getting food or liquid safely into your esophagus
- Difficulty getting your swallow started
- Difficulty moving food or liquid from the front of your mouth to the back
- Frequent hoarseness
- Persistent voice irritation, throat pain and/or pain when speaking
- Raspy or gravelly voice quality
- Strained speech
- Trembling voice
- Vocal fatigue
- Voice breaks and/or periods of not being able to speak
Inpatient Services
Our team of speech-language pathologists see patients throughout the medical center. We help patients with a variety of concerns and conditions, including:
- Evaluation and management of swallowing disorders
- Management of tracheostomy
- Alternative and Augmentative Communication (AAC)
- Communication assessment, management and support
Once we are consulted, we will continue following you throughout your stay for as long as you need our service.
Conditions We Treat
Voice disorders (called dysphonia) have a variety of causes and symptoms. Among other things, you may experience: chronic hoarseness and/or breathiness; deterioration of your voice with use; straining to speak; difficulty speaking loudly; loss of pitch range, tremor, voice turning on and off; and/or pain when speaking or singing.
We have a dedicated team of speech-language pathologists who are expert voice clinicians and who partner closely with our laryngology team. We evaluate and treat the entire spectrum of voice disorders, including:
- Muscle tension dysphonia
- Vocal fold lesions (e.g., nodules, cysts, polyps, granulomas)
- Voice injuries (e.g., vocal fold hemorrhage, laryngeal trauma)
- Vocal fold paresis and paralysis
- Laryngeal dystonia (previously called spasmodic dysphonia)
In your first visit with our team, we will complete an evaluation that includes your case history, examination of your face, neck, and laryngeal structures (laryngeal stroboscopy), as well as have you complete a number of voice tasks.
These will help us understand the most effective way to help you. If we recommend voice therapy, our team will help you use exercises to rehabilitate your voice and meet your functional goals.
More About Speech Therapy
Head and Neck Cancer
Head and neck cancer can affect your mouth, throat, tongue, voice box, nasal cavity and sinuses. Your treatment may include surgery, radiation and/or chemotherapy. The side effects from these treatments can result in difficulties with swallowing and communication, such as:
- Difficulty swallowing
- Pain with swallowing
- Dry mouth
- Changes in taste
- Thick secretions
- Voice changes or loss of voice
- Reduced jaw opening
- Lymphedema
Navigating the challenges associated with this diagnosis and treatment can be difficult; our clinician’s are trained in the management of head and neck cancer and can provide the following services:
- Assessment of swallowing
- Pre-radiation counseling
- Swallow preservation intervention for patients actively undergoing radiation
- Post radiation swallow therapy
For patients planning to or have already received a total laryngectomy, we also offer:
- Pre- and post-laryngectomy counseling
- Tracheoesophageal (TEP) voice prosthesis care and management
- Electrolarynx training
A diagnosis of head and cancer can be life altering. That’s why our team of Speech Language Pathologists are devoted to providing quality care and supporting a patient at any stage in their journey with this disease.
Parkinson’s Disease
Parkinson’s Disease is a progressive neurological disorder that affects the nervous system that can affect both speech and swallowing. Symptoms may include:
- Reduced volume of voice
- Voice breathiness
- Hoarseness
- Slurred speech
- Tremor
- Coughing while eating or drinking
- Drooling
- Prolonged mealtimes
- Weight loss
Our clinicians are trained in the assessment and treatment of speech, voice and swallowing. We provide the following services for patients diagnosed with Parkinson’s Disease:
- Speak Out!(R) evaluation and therapy
- Pre-Deep Brain Stimulation (DBS) voice evaluation
- Assessment of swallowing
- Swallow therapy and management
Upper Airway Disorders
The Voice, Speech and Swallowing team has specialists who care for people with a variety of upper airway concerns, including:
- Chronic cough and/or throat clearing
- Inducible Laryngeal Obstruction, also known as Paradoxical Vocal Fold Motion (PVFM) or Vocal Cord Dysfunction (VCD)
- Shortness of breath that is out of proportion to pulmonary or cardiac condition
Our team of speech-language pathologists see patients throughout the medical center. We help patients with a variety of concerns and conditions, including:
- Evaluation and management of swallowing disorders
- Management of tracheostomy
- Alternative and Augmentative Communication (AAC)
- Communication assessment, management and support
Once we are consulted, we will continue accompanying you throughout your stay for as long as you need our service.
At BIDMC, you have access to state-of-the art imaging and diagnostic tests. The tests help us learn the cause of your symptoms. That information helps us determine your treatment.
Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
FEES is a swallowing test. We use it to take video pictures of your voice box and throat while you eat and drink. For the test, we place a bendable tube in your nose and down your throat. We may ask you to swallow, speak, cough or clear your throat during your exam.
Laryngeal Endoscopy
An endoscopic laryngeal evaluation examines your voice box and throat with a tool called an endoscope. The endoscope is a thin, flexible tube with a camera on the tip. We pass the endoscope through your nose to your throat.
Video Swallowing Study
A video swallowing study helps us identify the causes of dysphagia (swallowing difficulty) and other disorders. We may use the test to help you learn how to improve swallowing problems.
We base treatment on your specific condition. Sometimes, treatment begins during a hospital stay. An SLP may conduct a swallowing or speech evaluation at your bedside. Then, if needed, they may recommend certain tests. Treatment is aimed at helping you communicate your needs and swallow safely. It may continue on an outpatient basis after you leave the hospital. Many treatments are available.
Aphasia Therapy
Aphasia therapy focuses on helping you use retained language abilities and restore abilities you’ve lost. It can also help you learn new ways of communicating.
Cardiopulmonary Treatment
We evaluate your heart and lung function including vital sign response to physical activity and exercise. We can prescribe an individualized exercise plan at an intensity that is right for you. We can teach you breathing exercises and perform interventions to help clear pulmonary secretions.
Swallowing Disorders Treatment
A swallowing disorder, otherwise known as dysphagia, can impact any part of the swallow. The swallow can be separated into three stages: oral phase (mouth), pharyngeal phase (throat), and esophageal phase (the tube between your throat and your stomach). Speech Language Pathologists are experts on the assessment and treatment of both the oral and pharyngeal phase of swallowing.
Our team of experts will assess your swallow either clinically, or through an instrumental assessment of swallowing using video fluoroscopy or endoscopy. Based on the findings, diet modifications and/or a course of swallow therapy may be recommended. Your treatment course will be tailored to the specific deficits that were identified during your swallow study.
Dysphagia is always a symptom of an underlying condition. Some conditions that may result in dysphagia include:
- Anatomical abnormalities (such as diverticulum, strictures, webs, osteophytes, etc.)
- Head and neck cancer
- Laryngeal dysfunction
- Neurological disorders (such as Parkinson’s Disease, ALS, Huntington’s Disease, dementia, myasthenia gravis, muscular dystrophy, etc.)
- Stroke
- TBI or any injury to the brain
Possible signs of dysphagia:
- Changes in vocal quality
- Coughing while eating or drinking
- Drooling
- Food or liquid coming out of your nose
- Inability to swallow
- Pain when swallowing
- Regurgitation of food or liquid
- Sensation of food or liquid feeling “stuck”
- Weight loss
If you’re having signs and symptoms of dysphagia, alert your primary care physician or specialty doctor. They can refer you for a swallow evaluation and treatment.
Passy-Muir Valve Evaluation
With some medical conditions, you might require a tracheostomy. This is a procedure that involves creating a hole in your trachea (windpipe) from outside your body. The hole helps oxygen reach your lungs, but it makes speaking difficult.
A Passy-Muir Valve (PMV) is a one-way valve that is placed at the end of the tracheostomy tube that goes in your neck. The PMV allows you to breathe, but it closes when you exhale. The closure directs air through your vocal cords for voice production. The air then enters your mouth, where you shape it into speech.
Our SLP works closely with a registered nurse and/or respiratory therapist if you require a ventilator to breathe.
Specialized Voice Care
You can get specialized care for voice disorders through our voice therapy program. That care ranges from relatively simple treatments, such as massage, to surgery for cancers of the voice box. Care for the professional voice and transgender voice is also available.
Swallowing Therapy
If you have a swallowing problem, we teach you about food consistencies. We help you learn to prepare foods in a way that will make them easier to swallow. We also teach you exercises to improve the strength, timing and coordination of your swallow. Sometimes, learning better ways to position yourself is helpful, too.
Upper Airway Disorder Treatment
A SLP can teach you ways to improve your breathing. This may involve relaxation, exercise and new breathing techniques. They may also provide pre-surgery counseling if surgery is in your future.
Directions to Clinic on the West Campus
From Longwood Avenue take Pilgrim Road to the Farr Building on West Campus. After entering the Farr lobby turn left at the gift shop and follow the corridor until you come to a waiting room with large windows. Span 106 is directly across from this waiting area.
You may also receive assistance locating us from any of our Information Desk staff at the hospital. Campus maps and directories are located at all of the Information Desks.
West Campus Parking Garage Locations
Pilgrim Road Garage
The cashier is located at the exit. Customers pay just before returning to their cars.
Hours: Open 24 hours per day.
110 Francis Street Garage
The cashier is located at the exit.
Hours: Monday – Friday, 5:00 am – 6:00 pm. Closed Saturday and Sundays.
Directions to Radiology for Videoswallow Evaluations
Outpatient Modified Barium Swallow studies are performed in the radiology department.
East Campus – Rabb Building
Park near the Feldberg lobby. Enter through the Main Entrance at 330 Brookline Avenue, then ask the staff at the information desk to guide you to the Rabb building. Once there, take the elevators to the third floor and check in at the outpatient Radiology department.
West Campus – Rosenberg Building
Park in the Pilgrim Road garage or valet park at the Rosenberg building (Emergency entrance). Enter the Rosenberg lobby and turn left. Then, take the elevators at the end of the hall to the 3rd floor and check in at the outpatient radiology department.
You can reach our scheduling office at 617-632-7400. You will need a doctor’s order to receive services in our clinic. Many insurance companies require an insurance referral as well. Check your plan documents for rules about speech therapy.
If your doctor doesn’t have access to our Epic medical record system, they can fax an order to 617-632-7401.
