- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04710862
The Effects of Respiratory Training on Voice
September 9, 2023 updated by: Soren Lowell, Syracuse University
The Effects of Respiratory-Based Treatment for Muscle Tension Dysphonia: A Randomized Controlled Trial
Primary muscle tension dysphonia is a voice disorder that involves excessive and poorly coordinated muscle activity affecting multiple subsystems that are involved in speech production, in the absence of structural or neurologic abnormalities of the larynx.
Primary muscle tension dysphonia (MTD) is one of the most common forms of voice disorders, accounting for at least 40% of patients seen in voice clinics.
Perceptually the voice sounds hoarse and strained, with reduced loudness and pitch range, and people with MTD find speaking very effortful and fatiguing.
The physiological abnormalities that characterize MTD are considered multifactorial, and include over-activity of muscles in and around the larynx, laryngeal constriction patterns, and abnormal speech breathing patterns.
However, standard treatment approaches for MTD primarily address laryngeal function, including repositioning of laryngeal structures, reducing activity in the intrinsic and extrinsic laryngeal muscles, and altering vibratory patterns.
Although voice improvement may follow these treatments, many people with MTD show recurrence of voice problems after only a few months, and some do not improve with treatment.
These findings highlight the need for alternative treatments that address the respiratory contributions to MTD, which directly affect the phonatory system.
The goal of this project is to compare the effects of two respiratory-based training conditions in people with MTD.
A randomized group design will be implemented to determine the respiratory and acoustic effects of each condition.
We will determine the effects of each condition immediately after and then 3 and 6 months after training completion to assess short- and long-term training effects.
We propose that respiratory training will have a positive effect on related laryngeal behavior and voice.
The proposed project has the potential to substantially advance the evidence-based treatment options for MTD, providing a vital step toward reducing the debilitating effects of this disorder.
Study Overview
Status
Recruiting
Conditions
Intervention / Treatment
Study Type
Interventional
Enrollment (Estimated)
36
Phase
- Not Applicable
Contacts and Locations
This section provides the contact details for those conducting the study, and information on where this study is being conducted.
Study Contact
- Name: Soren Y Lowell, PhD
- Phone Number: 3154439648
- Email: slowell@syr.edu
Study Locations
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New York
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Syracuse, New York, United States, 13244
- Recruiting
- Syracuse University
-
Contact:
- Soren Y Lowell, PhD
- Phone Number: 315-443-9648
- Email: slowell@syr.edu
-
-
Participation Criteria
Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.
Eligibility Criteria
Ages Eligible for Study
18 years and older (Adult, Older Adult)
Accepts Healthy Volunteers
No
Description
Inclusion Criteria:
- Ages 18 or older
- Self-report of general good health other than voice disorder
- Self-report of normal pulmonary function
- Non-smoker status for at least the last 5 years
- English as their primary language to avoid potential linguistically-based differences in acoustic measures of voice
- Adequate visual acuity (with or without corrective lenses) to read basic graphs and print, as determined with visual screening
- No evidence of current organic or neurologic laryngeal pathology, as assessed by nasolaryngoscopy examination and reviewed by a laryngologist
- No prior surgery to the vocal folds
- Do not report difficulty with swallowing
- Not currently receiving voice therapy or other voice treatment that cannot be discontinued
- Do not report a bilateral, severe to profound hearing loss
- Willingness to be recorded for data collection that is necessary for this study
- Have a confirming diagnosis of Muscle Tension Dysphonia from an otolaryngologist and speech-language pathologist
- Demonstrate quantified auditory-perceptual dysphonia and acoustic dysphonia (Cepstral/Spectral Index of Dysphonia) that exceed normative values for the participant's age and sex
- Based on the nasolaryngoscopy examination and assessment performed by the otolaryngologist, show one or more patterns of supraglottic activity that are consistent with adducted vocal fold hyperfunction
- Show no evidence of abnormal, incomplete vocal fold closure patterns as determined on the videostroboscopy assessment (patterns of posterior glottal gaps are normal and expected)
- Show no evidence of additional neurological voice disorders such as spasmodic dysphonia or vocal fold paralysis
- Show elevated hyolaryngeal position that exceeds normative expectations as determined through quantitative analysis of ultrasonographic laryngeal images measuring change from rest to phonation
- Demonstrate voice problems that have persisted for ≥2 months
- Demonstrate self-reported increase in speaking effort
- Show evidence of speech breathing abnormalities relative to accepted normative values
Exclusion Criteria:
- Ages 17 or younger
- Self-report of major health problems
- Self-report of pulmonary disease such as asthma, chronic obstructive pulmonary disease, or emphysema
- Current smoker status or prior smoker status within the last 5 years
- English not the primary language
- Inadequate visual acuity (with corrective lenses if applicable) to read basic graphs and print as determined by failing a visual screening
- Evidence of current organic or neurologic laryngeal pathology, as assessed by nasolaryngoscopy examination and reviewed by a laryngologist
- Prior surgery to the vocal folds
- Currently receiving voice therapy or other voice treatment that cannot be discontinued
- Self-report of a bilateral, severe to profound hearing loss
- Not willing to be recorded for data collection that is necessary for this study
- No confirming diagnosis of Muscle Tension Dysphonia from an otolaryngologist and speech-language pathologist
- Do not demonstrate quantified auditory-perceptual dysphonia and acoustic dysphonia (Cepstral/Spectral Index of Dysphonia) that exceed normative values for the participant's age and sex
- Based on the nasolaryngoscopy examination and assessment performed by the otolaryngologist, do not show one or more patterns of supraglottic activity that are consistent with adducted vocal fold hyperfunction
- Show evidence of abnormal, incomplete vocal fold closure patterns as determined on the videostroboscopy assessment (patterns of posterior glottal gaps are normal and expected)
- Show evidence of additional neurological voice disorders such as spasmodic dysphonia or vocal fold paralysis
- Do not show elevated hyolaryngeal position that exceeds normative expectations as determined through quantitative analysis of ultrasonographic laryngeal images measuring change from rest to phonation
- Demonstrate voice problems that have persisted for less than 2 months
- Do not demonstrate self-reported increase in speaking effort
- Do not show evidence of speech breathing abnormalities relative to accepted normative values
Study Plan
This section provides details of the study plan, including how the study is designed and what the study is measuring.
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Double
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Active Comparator: Breathing training with a device
Respiratory intervention delivered once a week for 6 weeks, after two initial baseline testing sessions.
Participants will perform exhalation exercises through a breathing device.
Homework activities will be assigned.
Post-training testing sessions will also be conducted.
|
Breathing training with a mouth device
|
Active Comparator: Breathing training without a device
Respiratory intervention delivered once a week for 6 weeks, after two initial baseline testing sessions.
Participants will receive training on the use of breathing techniques without a device, but with visual feedback throughout training.
Homework activities will be assigned.
Post-training testing sessions will also be conducted.
|
Breathing training without a mouth device
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Lung Volume Initiation
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Average level of lung volume at which speech breaths are initiated, expressed in percent vital capacity relative to resting expiratory level.
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
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Change in Lung Volume Termination
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Average level of lung volume at which speech breaths are terminated, expressed in percent vital capacity relative to resting expiratory level.
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Change in Lung Volume Excursion
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Average level of lung volume at which speech breaths are terminated, expressed in percent vital capacity.
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Change in Cepstral Peak Prominence
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Average energy in first cepstral peak relative to overall cepstral energy, measured in cepstral decibels
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Change in Cepstral/Spectral Index of Dysphonia
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
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Average multivariate measure of spectral and cepstral voice features that reflects the amount of acoustic voice disorder severity.
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in Auditory-Perceptual Overall Severity of Voice Disorder
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Listener-rated assessment of overall voice disorder severity on a 0-100 millimeter visual analog scale.
The minimum value is 0 and the maximum value is 100 on this scale.
Higher scores mean greater voice disorder severity.
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Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
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Change in Voice Handicap Index-10
Time Frame: Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
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Participant self-ratings of the impact and disability of the voice disorder.
The Voice Handicap Index-10 is a rating scale questionnaire with 10 questions, each scored on a scale of 0 (Never happens) to 4 (Always happens).
Higher scores mean greater handicap and disability from the voice disorder.
|
Assessed during initial baseline testing and approximately 7 weeks later directly after training completion.
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Investigators
- Principal Investigator: Soren Y Lowell, PhD, Syracuse University
Study record dates
These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.
Study Major Dates
Study Start (Actual)
May 12, 2021
Primary Completion (Estimated)
June 30, 2024
Study Completion (Estimated)
August 31, 2024
Study Registration Dates
First Submitted
November 30, 2020
First Submitted That Met QC Criteria
January 12, 2021
First Posted (Actual)
January 15, 2021
Study Record Updates
Last Update Posted (Actual)
September 13, 2023
Last Update Submitted That Met QC Criteria
September 9, 2023
Last Verified
September 1, 2023
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 20-132
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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