CLEARER: A Combined LaryngEAl and REspiratory AppRoach to Presbyphonia Voice Therapy
Presbyphonia
This cross-sectional observational study is the first phase of a multiphase project to design and test the feasibility of a novel combined laryngeal and respiratory-focused treatment for presbyphonia. This phase seeks to characterise the respiratory presentation and speech-related breathing patterns of people with presbyphonia and identify how these correlate with the subjective experience of vocal handicap. Potential participants will be identified from voice-specialist ENT clinics at four London NHS Trusts (University College London Hospitals (UCLH), Guy's Hospital, Northwick Park Hospital and Lewisham University Hospital) where the initial diagnosis of presbyphonia will be made by an ENT consultant surgeon. During routine care at these voice clinics, high-quality images of participant larynges will be recorded as per local Trust policy. Participants will be approached with information about the present study by a member of their clinical team (speech therapist or ENT consultant), and permission sought to pass their details on to the research team (see later section on recruitment). The study aims to recruit 14 males and 21 females as this number of participants is predicted to give sufficient power (0.8) in both groups to detect a minimum clinically significant difference in speech breathing metrics from published data (which is stratified by sex) using a two-sided single-sample t-test. Recruitment and data collection are expected to take place over 7 months. Audit data from the four PIC sites predicts that this will require approximately 50% of all identified people with presbyphonia to take part in the study, however, participants may also be drawn from current patients on waiting lists for voice therapy, increasing the number of potential participants. Data collection will take place in a single 2-hour research session at the Royal National ENT Hospital (UCLH). The session will include non-invasive procedures including breathing tests (spirometry), speech
1. 50 years of age or older 2. Ear, nose and throat (ENT) consultant-confirmed diagnosis of presbyphonia 3. Laryngeal images available for analysis 4. Typical hearing (as indicated by hearing screening at 40 dB HL at 500, 1000 and 1500Hz, bilaterally). 5. Willing and able to offer informed consent
1. Recent (< 12 months) voice therapy 2. Diagnosis of a neurological condition affecting laryngeal or respiratory function (i.e. Parkinson’s disease, CVA, spasmodic dysphonia) 3. Diagnosis of additional laryngeal pathology 4. Contraindicated for spirometry 5. Failing cognitive screen (< 23 on the Rowland Universal Dementia Assessment Scale, RUDAS)