The effectiveness of device-driven Expiratory Muscle Strength Training (EMST) in total laryngectomy patients; A pilot study

Abstract

Background Pulmonary function and voice quality of patients after a total laryngectomy has improved over the last decades with the development and use of heat and moisture exchangers (HME) and speech with the voice prosthesis. However, problems with coughing and mucus clearing and its negative consequences on voice quality are still often mentioned complaints. Expiratory muscle strength training (EMST) is a device-driven treatment for improving expiratory pressure generating capacity. Evidence of its benefits has been assessed in a group of healthy elderly, a group with Parkinson disease and in a group of stroke patients. Aim EMST was tested in this pilot study in a group of total laryngectomized participants to assess the feasibility and effect on expiratory muscle strength. Secondary objective was to assess the effects of EMST on phonation time, vocal range and voice related quality of life. Method Nine laryngectomized participants performed a four weeks EMST program. Maximum Expiratory Pressure (MEP) and Peak Expiratory Flow (PEF) served as primary outcome measures. Maximum phonation time (MPT), vocal range, VHI-10 and study specific questions were secondary outcome measures. Results MEP significantly improved over time (Chi-Square 22.64; p = .000). No significant effect were found for PEF from baseline to the end of training (Chi-Square 3.73; p = .444). No significant effects were found for any of the secondary voice related outcome measures. Conclusion A four week expiratory muscle strength training program seems feasible in a group of total laryngectomized participants and seems appropriate to improve the maximum expiratory pressure. Recommendations It should be considered to test EMST in a group less fit participants who mentioned explicitly problems of slime and difficulty with coughing. It is recommended to give special attention at the exhaling technique used during training.