Cancer of the Head and Neck Clinical Trial
Official title:
The Effects of Expiratory Muscle Strength Training (EMST) on Airway Protection and Swallowing in Chronic Dysphagia After Radiation Therapy
Radiation therapy for head and neck cancer (HNC) is associated with the development of
swallowing difficulties, or dysphagia. Dysphagia has profound negative effects on the health,
nutritional status, and quality of life of HNC survivors. It also puts them at risk of
developing life-threatening aspiration pneumonia. Radiation-associated dysphagia can be
intractable and not responsive to conventional dysphagia therapy. HNC survivors with chronic
severe dysphagia may be dependent on long-term tube feeding.
Expiratory Muscle Strength Training (EMST) is a low-cost, device-driven therapy. It has been
studied as an approach to simultaneously improve cough and swallowing functions. During EMST,
patients forcefully expire into a one-way spring-loaded valve to strengthen expiratory and
submental musculature. The EMST-150 device is available for clinical use in Singapore. In
other research studies, it has been shown to improve cough and swallowing in several
populations of people with chronic dysphagia, most recently in people with chronic
radiation-associated dysphagia.
The investigators propose to study the effect of EMST using the EMST-150 device on cough,
airway protection, and swallowing functions of HNC survivors with radiation-associated
dysphagia.
The investigators will recruit 40 participants to undergo an 8-week EMST programme, with
weekly follow-up to calibrate their EMST device. It is hypothesised that EMST will improve
participants' respiratory and swallowing functions. Respiratory function improvement will be
shown by increased maximum expiratory pressure and improved cough airflow measures.
Swallowing function improvement will be evidenced by reduced aspiration or improved ability
to clear aspirated material during videofluoroscopic swallow studies. The investigators also
hypothesize carryover effects on other aspects of swallowing, such as improved hyoid and
laryngeal excursions, and improved laryngeal vestibule closure.
With the results of this study, the investigators aim to develop better evidence-based
rehabilitation programmes for HNC survivors, and those living with chronic dysphagia.
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