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The latest study by Van Gogh et al. shows that voice therapy after laser surgery or radiotherapy for small tumours contributes towards voice improvement (Van Gogh, Verdonck-de Leeuw et al. 2006). In a study by Speyer et al., too, half of the patients treated for a benign tumour showed significantly improved stroboscopy recordings after three months of therapy (Speyer, Wieneke et al. 2002). In patients with unilateral vocal fold paralysis (80% of which was caused by a thyroidectomy), as shown in a study by D\u2019Alatri et al. (D\u0027Alatri, Galla et al. 2008), voice ratings improved significantly upon early voice therapy. Jongmans et al. furthermore shows that with targeted therapy in a group of tracheoesophageal speakers the difference between voiced and unvoiced sounds would improve significantly (Jongmans, Hilgers et al. 2006).\u000DThere are, however, few known studies that assess the efficacy of voice therapy after treatment of larger tumours, often involving a combination of chemotherapy and radiation (Jacobi, van der Molen et al. 2010).\u000D5.3.3 Speech problems resulting from head and neck cancer\u000DSurgical procedures in the head and neck area often impact the patient\u2019s articulatory functions. Speech is of major influence on the patient\u2019s wellbeing (Fung, Yoo et al. 2001, Peeters, van Gogh et al. 2004). Speech encompasses the patient\u2019s emotions, personality and identity (Rosen and Sataloff 1997). Since speech plays such a major role in daily communication, impairments in this area are often experienced as handicaps (Rieger, Dickson et al. 2006, Van Gogh, Verdonck-de Leeuw et al. 2006).\u000DThe treatment modality and its impact on the speech function depend on the location and the size of the tumour in the head and neck area. Tumours discovered at an early stage are generally treated with a single modality (laser, surgery or radiation). Larger tumours usually require a multi-modal protocol (such as radiation and chemotherapy, or surgery and radiation) (Ward and van As-Brooks 2007, Lango 2009).\u000D5.3.3.1 Effects of the oncological treatment on speech intelligibility\u000DSurgical procedures may cause nerve damage, but they may also involve disruption or replacement of parts of the articulators. This impairs the function of the speech organ, which means that patients must compensate for these limitations in order to remain intelligible. If the normal pattern needed for the production of a speech sound cannot be fully performed anymore, this may lead to distortion, omission or substitution of the sound, or to the production of additional speech sounds (Stes 1997, Van Gogh, Mahieu et al. 2007). Resection of the tongue and the soft palate in particular have been shown to have severe consequences for speech intelligibility (Kreeft, van der Molen et al. 2009). The tongue is the most important articulator and complete velopharyngeal closure, too, is crucial for intelligible articulation. Incomplete closure adversely affects swallowing and hampers the intraoral build-up of pressure, thus impairing the production of important sounds (Michi 2003). Even after reconstruction or with the use of a soft palate prosthesis the speech sound remains altered, thereby severely hampering social functioning for this patient group (Rieger, Dickson et al. 2006).\u000DSpeaking is negatively affected not only by surgical procedures, but also by radiotherapy treatment. Radiotherapy has side effects and sequels such as scarring, oedema, mucositis, pain and/or changes in the hydration of the oral cavity/pharynx, which may negatively impact the speech organs and the articulatory movements. Depending on the radiation dose, the irradiated area is damaged to a certain extent, possibly leading to skin and/or tissue ulceration (Ward and van As-Brooks 2007). In extreme cases atrophy, fibrosis and/or necrosis may occur. Furthermore, dysphagia, pneumonia (due to aspiration) or osteoradionecrosis may arise (Van den Broek, Balm et al. 2006). The combination of\u000D111\u000D