Summary
Objectives
Presbyphonia negatively impacts quality of life in patients with age-related voice
changes. A proof-of-concept study showed promise for high vocal intensity exercise
to treat presbyphonia, which became the basis for a novel intervention for age-related
voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory
Muscle Strength Training (EMST) has also been proposed as an additional intervention
to target and strengthen the aging respiratory system; however, EMST has undergone
limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy
for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy
(PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone.
Study Design
Prospective, randomized, controlled, single-blinded, non-inferiority.
Materials and Methods
Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized
to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated
measures linear mixed models were constructed to analyze outcomes at a significance
level of α = 0.10.
Results
Twenty-six participants were recruited for the study, and 24 participants were randomized
to either treatment arm. Sixteen participants completed the entire study. Both treatment
arms showed statistically significant and clinically meaningful improvements in VHI-10
(PhoRTE mean [M] = -8.20, P < 0.001; PhoRTE + EMST M = -9.58, P < 0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment
decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum
expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm H2O, PhoRTE + EMST M = 32.63 cm H2O; P= 0.015). Some secondary acoustic and aerodynamic outcomes displayed trends toward
improvement.
Conclusion
This study demonstrates that voice therapy targeting high vocal intensity exercise
(eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with
presbyphonia.
KEY WORDS
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Article info
Publication history
Published online: March 16, 2021
Accepted:
February 11,
2021
Identification
Copyright
© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
