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5.3. Logopaedics\u000D5.3.1 Swallowing problems (dysphagia) resulting from head and neck cancer\u000DOne of the main problems of head and neck oncology and its treatment (including surgery, radiotherapy, chemotherapy, photodynamic therapy (PDT), or a combination of those) is the often severe swallowing impairments that occur in 30-50% of patients during and/or after the oncological treatment (Machtay, Moughan et al. 2008, Caudell, Schaner et al. 2009). Not only tissue damage from the tumour itself, but also the head and neck oncology treatment can result in a damaging of the neuromuscular or sensory input (Nguyen, Kratz et al. 2013, Starmer, Quon et al. 2015). These injuries may negatively affect any stage of the swallowing function. Also, various safety mechanisms of the swallowing movement, such as larynx elevation, can be negatively affected by head and neck oncological treatment, with (silent) aspiration as a possible consequence.\u000D5.3.1.1 Effects of treatment\u000D5.3.1.1.2 Dysphagia after radiotherapy\u000DSince the 1960s, radiotherapy has played an important role in head and neck cancer treatment with curative intent. However, a consequence of this form of treatment is that significantly more patients present with swallowing problems. The cause of this lays in the fact that radiotherapy in the head and neck area may result in reduced functioning of the tongue, the larynx and the pharyngeal muscles. Acute problems, such as mucositis, swallowing problems, hoarseness and skin reactions, and chronic problems such as scarring, osteoradionecrosis, trismus, xerostomia and caries, are also frequently occurring sequels of radiotherapy (Trotti 2000). The severity of the effects of radiotherapy have been found to be dependent on the total number of radiation doses, radiation field, fractionation, and treatment duration (Trotti 2000, Rubira, Devides et al. 2007, Caudell, Schaner et al. 2010, Denaro, Merlano et al. 2013, Van der Molen, Heemsbergen et al. 2013, Starmer, Quon et al. 2015). A study by Ribura et al. analysed the oral condition of 100 head and neck cancer patients who had received radiotherapy (Rubira, Devides et al. 2007). At an average of 28 months after radiotherapy 30% of patients were found to experience loss of taste, 38% had swallowing problems, and 68% presented with a dry mouth. Wu et al. assessed swallowing safety in 31 nasopharynx cancer patients (Wu, Hsiao et al. 1997). The average follow-up time after radiotherapy was 8.5 years. The study also showed that 93.5% of the patients showed pharyngeal contrast residue after swallowing a bolus and that 77.4% showed laryngeal aspiration. A study by Hutcheson et al. similarly detected swallowing problems (Hutcheson, Barringer et al. 2008). The authors of this study analysed 40 patients with a laryngeal tumour for which they received radiotherapy. Of these patients, 84% aspirated and 44% did so without a cough response (silent aspiration). The primary causes for this were found to be impaired laryngeal movement, incomplete epiglottic inversion and reduced base of tongue retraction to the posterior pharyngeal wall. Due to persistent aspiration 78% of all patients received a nasogastric feeding tube during or after treatment. Of the patients with tumour-free status after treatment, 72% resumed oral intake. That is to say, 28% were still feeding tube dependent.\u000D5.3.1.1.2 Dysphagia after chemoradiation\u000DInstead of radiotherapy alone or surgical resection (with or without concomitant radiotherapy) a combination of radiation and chemotherapy (CRT) has come to play an important role in head and neck cancer treatment in the past few years. For patients with advanced cancer of the head and neck,\u000D103\u000D