Evaluating the Feasibility of Acapella® Choice as a Dysphonia Treatment

NCT ID: NCT04764604

Last Updated: 2023-08-01

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2020-12-14

Study Completion Date

2021-11-29

Brief Summary

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A feasibility study to identify the immediate effect on the voices of patients with voice disorders (muscle tension dysphonia, vocal fold palsy or presbylaryngis) produced by exercising with Acapella Choice as a form of semioccluded vocal tract exercise (SOVTE).

Detailed Description

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This feasibility study is the natural extension of the researchers' recently completed study (R\&D 16/0242) which assessed how the use of an Acapella Choice (Smiths Medical) positive expiratory pressure (PEP) device as a semi-occluded vocal tract exercise (SOVTE) impacted acoustic, electroglottographic and aerodynamic measures of the voice in a group of normophonic volunteers. In that study, Acapella Choice was found to offer significantly greater oscillating intraoral pressures than techniques in current clinical practice and was found to have measurable benefits in terms of producing a louder and more economical voice. It offered the largest oscillating pressures, likened to a 'massage' of the vocal organs, giving it great therapeutic promise for patients with excess vocal tract tension.

This study seeks to evaluate the immediate effects of Acapella Choice as a voice exercise in patients with Muscle Tension Dysphonia, Presbylaryngis and Vocal Fold Palsy, and compare this to the widely-used voice rehabilitation technique of phonation into a tube held under water (henceforward referred to as "Tube"). Patients will be recruited from four weekly Voice Clinics held at the Royal National Throat Nose and Ear Hospital where their diagnosis will be confirmed. They will be invited to attend a single experimental session during which time they will exercise both with Acapella Choice and with Tube. Baseline and outcome voice measures will be taken and a short questionnaire will be completed, eliciting perceptions of the two exercises and any changes which were felt to have resulted from them.

The researchers' previous work suggests that Acapella Choice as a SOVTE may offer significant clinical benefits in terms of improved efficacy of therapy. It is suggested that it also offers patients a more convenient and user-friendly form of exercise which may well improve compliance and result in better outcomes.

Conditions

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Muscle Tension Dysphonia Vocal Fold Palsy Vocal Cord Paralysis Presbylarynx Dysphonia

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

PARALLEL

This is a feasibility study using a 'before and after' design to test the immediate effects of exercising with Acapella Choice in comparison to the immediate effects of exercising with Tube-in-water resistance exercises (current treatment norm). Participants will be assigned groups according to their diagnosis (i.e. muscle tension group, vocal fold palsy group and presbylaryngis group). All participants will exercise with both techniques (i.e. Acapella and tube-in-water).
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Muscle Tension Group

10 participants with a diagnosis of muscle tension dysphonia will carry out two experimental interventions, with a 30 minute vocal rest period in between interventions:

1. Three minutes of semi-occluded vocal tract exercise with both Acapella Choice
2. Three minutes of tube-in-water semi-occluded vocal tract exercise.

Aerodynamic, acoustic and electroglottographic baselines will be taken before each intervention and repeated immediately post-intervention as outcomes.

Participants will also provide a self-assessment of voice quality, perceived ease of voice production and perceived strength of voice before and after each intervention.

Participants will additionally answer qualitative questions following each intervention regarding their perceptions of the task: ease performing, pleasantness, effort, practicality and likelihood of carrying out the task on a daily basis as a form of therapy.

Group Type EXPERIMENTAL

Acapella Choice

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through the device (on setting '5') and phonating at the same time.

Tube-in-water

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through a silicone tube (10mm internal diameter) submerged in 5 cm of water whilst phonating at the same time.

Vocal Fold Palsy Group

10 participants with a diagnosis of (unilateral) vocal fold palsy will carry out two experimental interventions, with a 30 minute vocal rest period in between interventions:

1. Three minutes of semi-occluded vocal tract exercise with both Acapella Choice
2. Three minutes of tube-in-water semi-occluded vocal tract exercise.

Aerodynamic, acoustic and electroglottographic baselines will be taken before each intervention and repeated immediately post-intervention as outcomes.

Participants will also provide a self-assessment of voice quality, perceived ease of voice production and perceived strength of voice before and after each intervention.

Participants will additionally answer qualitative questions following each intervention regarding their perceptions of the task: ease performing, pleasantness, effort, practicality and likelihood of carrying out the task on a daily basis as a form of therapy.

Group Type EXPERIMENTAL

Acapella Choice

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through the device (on setting '5') and phonating at the same time.

Tube-in-water

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through a silicone tube (10mm internal diameter) submerged in 5 cm of water whilst phonating at the same time.

Presbylaryngis Group

10 participants with a diagnosis of presbylaryngis will carry out two experimental interventions, with a 30 minute vocal rest period in between interventions:

1. Three minutes of semi-occluded vocal tract exercise with both Acapella Choice
2. Three minutes of tube-in-water semi-occluded vocal tract exercise.

Aerodynamic, acoustic and electroglottographic baselines will be taken before each intervention and repeated immediately post-intervention as outcomes.

Participants will also provide a self-assessment of voice quality, perceived ease of voice production and perceived strength of voice before and after each intervention.

Participants will additionally answer qualitative questions following each intervention regarding their perceptions of the task: ease performing, pleasantness, effort, practicality and likelihood of carrying out the task on a daily basis as a form of therapy.

Group Type EXPERIMENTAL

Acapella Choice

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through the device (on setting '5') and phonating at the same time.

Tube-in-water

Intervention Type DEVICE

3 minutes of exercise consisting of blowing through a silicone tube (10mm internal diameter) submerged in 5 cm of water whilst phonating at the same time.

Interventions

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Acapella Choice

3 minutes of exercise consisting of blowing through the device (on setting '5') and phonating at the same time.

Intervention Type DEVICE

Tube-in-water

3 minutes of exercise consisting of blowing through a silicone tube (10mm internal diameter) submerged in 5 cm of water whilst phonating at the same time.

Intervention Type DEVICE

Other Intervention Names

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PEP Semioccluded vocal tract exercise Lax Vox Resonance tube in water Semi-occluded vocal tract exercise

Eligibility Criteria

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Inclusion Criteria

* Able to understand written English without the need for an interpreter,
* No diagnosed communication impairment
* Endoscopically confirmed primary ENT diagnosis of either:

1. muscle tension dysphonia (with no laryngeal abnormality),
2. Vocal fold palsy
3. Presbylaryngis.

Exclusion Criteria

* Previous SLT input
* Any of the following possible contraindications for PEP therapy:

* Inability to tolerate increased work of breathing,
* ICP (intracranial pressure) \> 20mm Hg,
* Recent facial/oral/skull surgery or trauma,
* Oesophageal surgery,
* Untreated pneumothorax,
* Known or suspected tympanic membrane rupture/other middle ear pathology,
* Haemodynamic instability,
* Acute sinusitis,
* Epistaxis,
* Active haemoptysis,
* Nausea
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Smiths Medical, ASD, Inc.

INDUSTRY

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Brian Saccente-Kennedy, MSc

Role: PRINCIPAL_INVESTIGATOR

University College London Hospitals

Locations

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Royal National ENT Hospital, UCLH Hospitals NHS Trust

London, , United Kingdom

Site Status

Countries

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United Kingdom

References

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Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

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18/0434

Identifier Type: -

Identifier Source: org_study_id

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