A combined laryngeal and respiratory approach to presbyphonia voice therapy: feasibility trial (CLEARER)
Presbyphonia
This study is a non-randomised multicentre feasibility trial of CLEARER Voice Group mechanisms of action. The trial will run at UCLH and three additional NHS sites (Guy's Hospital, Charing Cross Hospital, and Whittington Hospital). These sites were selected because they already have awareness of the CLEARER project, established ENT/SLT services, and the specialist staff and equipment required to deliver the intervention safely and consistently. Baseline and outcome measurements will be conducted at UCLH, where specialist acoustic, aerodynamic, and perceptual assessment facilities are available. Pre- and post-intervention measures: Potential participants will be identified from SLT/ENT clinics or lists of patients referred to SLT teams and currently awaiting input for presbyphonia across the four study sites. Despite the use of multiple sites, consenting, screening, and registration will all occur centrally at UCLH during a consenting and baseline data collection appointment. Following informed consent, potential participants who pass an initial hearing and cognitive screen will undergo an approximately 75-minute baseline data collection session at UCLH. During this session, baseline data will be collected by the CI, who has the specialist training and equipment required. Participants will then return to their home study site to undergo CLEARER Voice Group treatment (see below). Once the treatment block has been completed, they will return to UCLH for repeat data collection and an exit interview. Group structure: Each site will deliver one block of six group sessions, each lasting approximately 90 minutes, with 3 to 5 participants per group. The CLEARER Voice Group is a structured, progressive programme combining: 1. High-resistance semi-occluded vocal tract training 2. Respiratory lung volume training, including incentive spirometer-guided breath work 3. Conversation Training Therapy, including clear speech, prosody, projection, and negative practice 4. Sensory di
1. 50 years of age or older 2. ENT consultant-confirmed diagnosis of presbyphonia 3. Laryngeal images from most recent (within 6 months) ENT exam available for analysis 4. Typical hearing (as indicated by hearing screening at 40 dB HL at 500, 1000, and 1500 Hz, bilaterally), wearing hearing aids (if applicable) 5. Comfortable using spoken English in a group conversation setting 6. Willing and able to provide informed consent
1. Recent (< 12 months) voice therapy 2. Current diagnosis of a neurological condition affecting laryngeal or respiratory function (i.e., Parkinson’s disease, CVA, spasmodic dysphonia) 3. Current diagnosis of additional laryngeal pathology 4. Contraindicated for spirometry (haemoptysis of unknown origin, pneumothorax, unstable cardiovascular status, ‘recent’ (< 6 weeks) myocardial infarction or pulmonary embolus , thoracic/abdominal/cerebral aneurysms, ‘recent’ (<6 weeks) eye surgery, nausea/vomiting, ‘recent’ (<6 weeks) thoracic/abdominal surgery) 5. Contraindicated for PEEP (haemodynamic instability (caused by cardiogenic shock, recent myocardial infarction, left heart failure, hypovolaemia), severe hypotension, severe COPD/asthma, raised intracranial pressure, diagnosis of an air leak syndrome (i.e., bronchopleural fistula) or unilateral lung disease) 6. Failing cognitive screen (scoring <23 on the Rowland Universal Dementia Assessment Scale [RUDAS])