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radiation with chemoradiation will exacerbate these side effects (Allal, Bieri et al. 1997, Van den Broek, Balm et al. 2006).\u000DAs is the case with voice quality and phonation, further impairments that may negatively affect speech function are reduced physical fitness, motor dysfunction and/or impaired lung function.\u000D5.3.3.2 Assessment methods for speech quality and intelligibility\u000DVarious methods are available for the assessment of speech quality. There is currently no consensus, however, on which method to use; intelligibility may, after all, be hampered by problems on various levels of speech and language acquisition, motor disruption, deafness, or altered/reduced phonation (Duinmeijer, van der Molen et al. 2010) and will require a different approach depending on the disorder. The selection of the appropriate assessment method depends on the patient group, or in this case tumour location and treatment modality. Other than in the case of voice characteristics, there is no (proposed) protocol for adequately mapping out typical speech problems in the head and neck cancer patient population. For head and neck cancer patients, intelligibility will be less impacted by cancer-related acquisition disorders, and more by treatment effects in the area of the motor system/articulation and voicing.\u000DSpeech intelligibility is first and foremost a perceptual process. In the area of speech intelligibility assessment the Frenchay Dyasthrya Assessment (FDA) appears to be among the most commonly used instruments (Duinmeijer, van der Molen et al. 2010); the Dutch version is the DYVA (Dharmaperwira- Prins 1996), of which the Dysarthria section predominantly maps out articulatory problems. Even though the test was developed for a disorder with a different cause, the scoring of for instance myogenous or bulbar dysarthria seems best equipped to chart the speech impairments known to occur in the head and neck oncology population. In addition, the Dutch intelligibility test (NVO) may be used to map out the problems of this patient group.\u000DSubjective intelligibility (assessment by the patient) can be measured with the use of patient questionnaires, such as the Speech Handicap Index (Rinkel, Verdonck-de Leeuw et al. 2008). Specialists, such as speech therapists, can analyse the patient\u2019s speech with the aim of mapping out their various speech levels and adjusting the therapy accordingly (Duinmeijer, van der Molen et al. 2010). If the goal is to test for specific articulatory impairments, the Fisher-Logemann test of Articulation Competence is often used (Fisher and Logemann 1971, Jacobi, van der Molen et al. 2010). Furthermore, automatic intelligibility scores for pathological speech are being developed, but due to their limited precision they currently do not offer a substitute for specialist assessment yet. Recently, advancements have been made in automatic intelligibility assessment for a more robust assessment of changes in intelligibility over time (Maier, Haderlein et al. 2010, Middag, Clapham et al. 2014).\u000D5.3.3.3 Speech therapy to improve intelligibility\u000DBefore, during or after organ preserving as well as surgical and/or reconstructive treatments most therapeutic exercises are aimed at increasing mobility and/or strengthening the tongue and jaw muscles (Ward and van As-Brooks 2007). To improve intelligibility the acquisition of (substitute) articulatory strategies in combination with an altered anatomy or prosthesis plays an important part (Michi 2003).\u000DAfter a total laryngectomy, voicing is often particularly altered by the surgical procedure. Apart from the voice, however, the quality of the speech may also be impacted. Especially due to the altered build-up of pressure necessary to produce certain sounds, the speech may be altered (Michi 2003). In the case of oesophageal speech, therapy aims particularly at consonant injection.\u000D112\u000D