The Additive Effectiveness of Inspiratory Muscle Training on Glottic Closure and Subjective Voice Outcomes of Patients With Benign Lesion After Hyaluronic Acid Laryngoplasty

Published:December 10, 2022DOI:



      For patients with glottic insufficiency disease, injection laryngoplasty is a rapid and efficient management option that complements voice therapy. Some studies have indicated that respiratory muscle training may also show promise in patients with voice disorders. However, the effect of respiratory muscle training in patients with glottic insufficiency was reported to be limited, and whether it provides additional benefit after standard management requires further evaluation. We aimed to investigate the effectiveness of inspiratory muscle training on glottis closure and patient-reported voice quality in glottic insufficiency patients who had been treated with hyaluronic acid injection.

      Study Design

      Retrospective observational study.


      We included 46 patients with glottic insufficiency who had undergone hyaluronic acid injection. Twenty of them had undergone inspiratory muscle training during three months. We measured patients’ changes in glottic status according to the normalized glottal gap area and bowing index, as well as voice quality of life according to the voice handicap index 10 and the voice outcome survey, before and after training.


      Patients who underwent inspiratory muscle training had higher odds of experiencing better improvement in all scores. The range of odds ratios ranged from 2.5 to 6.3 for changes in scores, and from 3.8 to 22.2 for changes in score percentages. Of note, the effect of training on percentage changes in the normalized glottal gap area score was significant (P= 0.0127) after adjustment for the duration of vocal disease, body mass index and BMI, and history of gastroesophageal reflux disease.


      Inspiratory muscle training can improve the glottal gap after injection laryngoplasty, and may be applied in clinical practice.

      Key Words


      BI (bowing index), CAPE-V (consensus auditory-perceptual evaluation of voice), EMT (expiratory muscle training), GERD (gastroesophageal reflux disease), GRBAS (grade, roughness, breathiness, asthenia, and strain), HA (hyaluronic acid), IA (injection augmentation), IMT (inspiratory muscle training), IQR (interquartile range), MEP (maximal inspiratory pressure), NGGA (normalized glottal gap area), PEF (peak expiratory flow), QOL (quality of life), RMT (respiratory muscle training), VHI-10 (Voice Handicap Index 10), VOS (voice outcome survey)
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