Expiratory Muscle Strength Training to Improve Voice and Respiratory Outcomes After Laryngectomy: A Feasibility Study

IF 2.1 3区医学 Q2 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY

International Journal of Language & Communication Disorders Pub Date : 2025-08-15 DOI:10.1111/1460-6984.70107

Freya Sparks, Margaret Coffey, Lucy Dipper, Jessica Crowther, Simon Hamilton, Louise Occomore-Kent, Katerina Hilari

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引用次数: 0

Abstract

Background

People with laryngectomy who use a tracheoesophageal voice prosthesis for communication experience changes to respiratory function resulting in reduced breath support and increased secretions. This impacts tracheoesophageal voice quality and volume. Expiratory muscle strength training (EMST) is an effective treatment for cough management, voice and respiratory function in other clinical populations, such as neurodegenerative conditions and benign voice disorders. There is limited evidence for the use of EMST in people with laryngectomy. This study explores EMST feasibility and preliminary efficacy with tracheoesophageal speakers. It is hypothesised that, like in other disorders, EMST can improve respiratory parameters and thus tracheoesophageal voice quality.

Aims

(1) To investigate the feasibility and acceptability of EMST after laryngectomy. (2) To determine the impact of EMST on respiratory function; participant-reported outcome measures (PROMS) of cough and secretion burden, voice-related quality of life and experiences of communication; objective and perceptual measures of tracheoesophageal voice quality.

Methods and Procedures

This was a before–after study with time (double baseline) providing experimental control. Participants completed a 5-week EMST protocol and 6-week maintenance period. Assessments were taken at two baselines, post-EMST and at 6-week follow-up: respiratory: maximum expiratory pressure (MEP), peak flow, forced expiratory volume (FEV1); PROMS: CASA-Q, SECEL, V-RQOL; voice: voice recording for perceptual (clinician-rated) analysis, maximum phonation time, decibels. One-way repeated measures ANOVA or Friedman tests were used as appropriate to explore the pattern of change. Effect sizes were reported.

Outcomes and Results

Ten participants (eight male and two female) completed EMST. Participants found EMST acceptable and beneficial, reporting subjective changes in breathing and exercise tolerance. There were no significant differences in any measures between the two baselines. Significant increase from baseline was found in peak flow, FEV1 and decibels post-EMST training and post 6-week maintenance period, respectively. MEP increased significantly from baseline to post-EMST training only. PROMS showed a reduction in cough impact, sputum symptoms and reduced self-evaluation of communication impairment post-EMST. There was a non-significant reduction in maximum phonation time and no significant differences in clinician-rated voice quality post-EMST training and maintenance periods. Participants required device modifications to enable safe usage of the device and to achieve an airtight connection at the neck stoma.

Conclusions and Implications

EMST is an acceptable treatment for tracheoesophageal speakers; however, device modifications are required to support usage and minimise airway safety risks. Preliminary efficacy data demonstrate that EMST may improve parameters of respiratory function, volume and self-perception of communication in PWL. A larger-scale randomised trial is required to increase the robustness of findings. It is recommended that device manufacturers develop adapters to facilitate airtight connection to neck stomas and to increase device safety in the laryngectomy population.

WHAT THIS PAPER ADDS

What is already known on this subject

According to existing evidence, EMST is an effective treatment for improving cough strength and respiratory function. However, knowledge on the use of EMST after laryngectomy is limited, with only one existing study in evidence (Van Sluis et al. 2020).

What this paper adds to existing knowledge

This innovative feasibility study provides evidence on the feasibility and acceptability of EMST with people with laryngectomy and preliminary data on its impact on perceptual and objective measures of tracheoesophageal voice, cough and secretion clearance.

What are the potential or actual clinical implications of this work?

Subject to further testing, EMST may be an appropriate treatment to consider improving respiratory function, secretion clearance, vocal loudness and self-perception of communication for tracheoesophageal speakers.

Abstract Image

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呼气肌力训练改善喉切除术后声音和呼吸预后的可行性研究

背景喉切除术后使用气管食道语音假体进行交流的患者会经历呼吸功能的改变，导致呼吸支持减少和分泌物增加。这会影响气管食道的声音质量和音量。呼气肌力训练（EMST）是治疗其他临床人群咳嗽、声音和呼吸功能的有效方法，如神经退行性疾病和良性声音障碍。在喉切除术患者中使用EMST的证据有限。本研究探讨EMST在气管食管扬声器中的可行性及初步疗效。据推测，与其他疾病一样，EMST可以改善呼吸参数，从而改善气管食管语音质量。目的(1)探讨喉切除术后EMST的可行性和可接受性。(2)确定EMST对呼吸功能的影响；参与者报告的咳嗽和分泌物负担、语音相关生活质量和交流体验的结果测量（PROMS）；气管食管语音质量的客观与感知测量。这是一项前后对照研究，时间（双基线）提供实验控制。参与者完成了5周的EMST方案和6周的维持期。在emst后和6周随访的两个基线上进行评估：呼吸：最大呼气压（MEP）、峰值流量、用力呼气量（FEV1）；逍遥音乐会：casa-q， secel, v-rqol；语音：语音记录用于感知（临床评定）分析，最大发声时间，分贝。在适当的情况下，使用单向重复测量ANOVA或Friedman检验来探索变化的模式。报告了效应量。10名参与者（8名男性，2名女性）完成了EMST。参与者发现EMST是可接受的和有益的，他们报告了呼吸和运动耐受性的主观变化。两个基线之间的任何测量均无显著差异。emst训练后和6周维持期后，峰值流量、FEV1和分贝分别较基线显著增加。从基线到emst培训后，MEP显著增加。在emst后，PROMS显示咳嗽影响、痰症状和沟通障碍的自我评价降低。在emst培训和维护期后，最大发声时间没有显著减少，临床医生评价的语音质量也没有显著差异。参与者需要对设备进行修改，以确保设备的安全使用，并在颈部造口处实现密封连接。结论与意义EMST治疗气管食管扬声器是一种可接受的治疗方法；然而，需要对设备进行修改以支持使用并将气道安全风险降至最低。初步疗效数据显示，EMST可改善PWL患者的呼吸功能、容积和自我沟通感知等参数。需要更大规模的随机试验来增加研究结果的稳健性。建议设备制造商开发适配器，以促进与颈部造口的紧密连接，并增加喉切除术人群的设备安全性。根据现有证据，EMST是改善咳嗽强度和呼吸功能的有效治疗方法。然而，关于喉切除术后使用EMST的知识有限，只有一项现有研究有证据（Van Sluis et al. 2020）。这项创新性的可行性研究为EMST在喉切除术患者中的可行性和可接受性提供了证据，并为其对气管食管声音、咳嗽和分泌物清除的感知和客观测量的影响提供了初步数据。这项工作的潜在或实际临床意义是什么？经进一步测试，EMST可能是考虑改善气管食管说话者呼吸功能、分泌物清除率、声音响度和自我交流感知的合适治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Language & Communication Disorders AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

3.30

自引率

12.50%

发文量

116

审稿时长

6-12 weeks

期刊介绍： The International Journal of Language & Communication Disorders (IJLCD) is the official journal of the Royal College of Speech & Language Therapists. The Journal welcomes submissions on all aspects of speech, language, communication disorders and speech and language therapy. It provides a forum for the exchange of information and discussion of issues of clinical or theoretical relevance in the above areas.