PhoRTE® Therapy Efficacy: In-Person Versus Telehealth

NCT ID: NCT06934265

Last Updated: 2026-01-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

30 participants

Study Classification

INTERVENTIONAL

Study Start Date

2026-01-25

Study Completion Date

2026-10-25

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This study compares how well voice therapy works when delivered in-person versus through telehealth for older adults with age-related voice problems. Researchers are testing whether Phonation Resistance Training Exercises (PhoRTE®) can be just as effective when delivered remotely as when done face-to-face, which could make treatment more accessible and affordable for seniors.

The two primary hypotheses are:

1. Does voice therapy (called PhoRTE®) work as well through video calls as it does face-to-face?
2. Can online therapy be a more accessible way for older adults to get help for their voice problems?

Adults aged 55 or older with voice changes and an applicable diagnosis will be randomly assigned to receive either in-person or telehealth therapy, consisting of four 45-minute sessions. After treatment, researchers will measure improvements through:

* Changes in voice function
* Patient reports about their voice
* Scientific measurements of voice quality
* Patient satisfaction with treatment
* Impact on quality of life

The results will help determine if telehealth can be a good alternative to in-person voice therapy, especially important as telehealth coverage may be changing.

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

This study employs a prospective, noninferiority cohort design to compare the efficacy of in-person versus telehealth delivery of Phonation Resistance Training Exercises (PhoRTE®) for adults aged 55+ diagnosed with presbyphonia.

Participants will be recruited from the USC Voice Center, a multidisciplinary otolaryngology clinic with four outpatient locations in Southern California. Eligible participants must have a primary diagnosis of presbyphonia, age-related voice change, and/or vocal fold atrophy.

The study will use stratified block randomization with a 1:1 allocation ratio to ensure equitable distribution of severity across both treatment groups (in-person and telehealth). Electronic randomization algorithms will be implemented to mitigate selection bias.

Treatment Protocol:

* Both groups will complete four 45-minute sessions of voice therapy
* Sessions will be conducted at weekly or biweekly intervals
* PhoRTE® therapeutic intervention involves exuberant vocalization techniques utilizing high-intensity phonation with expanded oral aperture configuration ("megaphone mouth shape") to optimize phonatory efficiency and augment vocal intensity without inducing vocal strain/hyperfunction

Assessment Measures:

1. Validated patient-reported outcomes:

1. Voice Handicap Index-10 (VHI-10) for quantification of perceived voice-related quality of life impairment
2. Aging Voice Index (AVI) for quantification of perceived voice-related quality of life impairment for aging populations
3. OMNI-Vocal Effort Scale for perceived assessment of effort with voicing
4. Voice Problem Impact Scales (VPIS) for multidimensional evaluation of voice-related quality of life
2. Expert clinical auditory/perceptual measures:

Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) for voice quality and severity Note: Blinded independent evaluation by voice \& upper airways-specialized (VUAD) speech-language pathologists (minimum 5 years specialization in voice disorders with ≥80% voice disorder caseload) analysis of recorded voice samples
3. Instrumental acoustic/aerodynamic measures:

1. Acoustic measures: cepstral peak prominence (CPP), CPP standard deviation (CPP SD), fundamental frequency (fo), and vocal intensity/loudness (dB SPL) in sustained vowels and connected speech - Aerodynamic measures: subglottal pressure (Psub), phonation threshold pressure (PTP), and mean airflow during voicing with corresponding duration and number of replenishing breaths during sustained vowels and connected speech

Data Collection Timeline:

* Baseline measures will be obtained at the initial interprofessional evaluation
* Post-intervention evaluations will occur one week after the terminal therapeutic session
* All measurement parameters will be repeated at both timepoints to assess treatment effects

Sample Size:

The target enrollment is 13-15 participants per treatment group (26-30 participants total), which aligns with previous research on PhoRTE® therapy for presbyphonia.

This protocol follows the tripartite model of evidence-based practice and therefore contains multiple primary outcomes through integration of patient-reported measures, clinical expertise, and instrumental assessment to comprehensively evaluate treatment efficacy across delivery modalities.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Atrophy of Vocal Cord Presbyphonia Dysphonia Glottic Insufficiency Voice Change Voice Disorder Adults Aging Speech Therapy Voice Alteration

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Each group will get the same intervention; however, delivery method will differ (in-person vs telehealth-delivered)
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Investigators
CAPE-V audio sample listeners will be blinded.

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

PhoRTE - IP

PhoRTE® voice therapy will be administered to this treatment arm in-person (IP)(traditional therapy).

Group Type ACTIVE_COMPARATOR

exuberant voice therapy

Intervention Type BEHAVIORAL

exuberant voice therapy validated for patients with age-related voice changes (i.e., vocal fold atrophy, presbyphonia)

PhoRTE - TH

Study participants who will be receiving intervention via telehealth. Intervention administered will be PhoRTE® voice therapy.

Group Type EXPERIMENTAL

exuberant voice therapy

Intervention Type BEHAVIORAL

exuberant voice therapy validated for patients with age-related voice changes (i.e., vocal fold atrophy, presbyphonia)

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

exuberant voice therapy

exuberant voice therapy validated for patients with age-related voice changes (i.e., vocal fold atrophy, presbyphonia)

Intervention Type BEHAVIORAL

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Phonation Resistance Training Exercises (PhoRTE®)

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Adults 55+ with a primary diagnosis of presbyphonia, age-related voice changes, and/or vocal fold atrophy with or without localized loss of lamina propria (e.g. vocal fold scar)
* Telehealth-capable device (e.g., tablet, computer) with microphone, speaker, camera, high-speed internet
* Ability to attend four telehealth or in-person sessions for four consecutive sessions
* Ability to attend two in-person evaluation sessions (pre- and post-treatment)

Exclusion Criteria

* Presence of localized masses, lesions, or vocal fold motion impairments identified during videostroboscopy at initial evaluation
* Progressive neurologic conditions, e.g. Parkinson's disease (PD), Amyotrophic lateral sclerosis (ALS), Progressive supranuclear palsy (PSP), etc.
* Previous attendance to exuberant voice therapy (e.g., PhoRTE, Lee Silverman Voice Treatment)
* Untreated hearing loss
* Non-English speakers
Minimum Eligible Age

54 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Southern California

OTHER

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Aaron Rothbart, PhD

Clinical Assistant Professor of Otolaryngology - Head and Neck Surgery (Clinician Educator)

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Aaron Rothbart, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Southern California

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

USC Voice Center

Arcadia, California, United States

Site Status

USC Voice Center

Beverly Hills, California, United States

Site Status

USC Voice Center

Glendale, California, United States

Site Status

USC Voice Center

Los Angeles, California, United States

Site Status

Countries

Review the countries where the study has at least one active or historical site.

United States

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Alexandra Chace Purdy, BM, MA

Role: CONTACT

607 592-9123

M. Eugenia Castro, MS CCC-SLP

Role: CONTACT

(323) 833-4530

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Alexandra Chace Purdy, BM, MA CF-SLP

Role: primary

323-442-5790

Maria Eugenia Castro, MS CCC-SLP

Role: backup

323-442-5790

Alexandra Chace Purdy, BM, MA CF-SLP

Role: primary

(310) 601-3367

Maria Eugenia Castro, MS CCC-SLP

Role: backup

(310) 601-3367

Alexandra Chace Purdy, BM, MA CF-SLP

Role: primary

(818) 507 9115

Maria Eugenia Castro, MS CCC-SLP

Role: backup

(818) 507 9115

Alexandra Chace Purdy, BM, MA CF-SLP

Role: primary

323-442-5790

Lauren Timmons Sund, BM, MS, CCC-SLP

Role: backup

323-442-5790

References

Explore related publications, articles, or registry entries linked to this study.

Shoffel-Havakuk H, Marks KL, Morton M, Johns MM 3rd, Hapner ER. Validation of the OMNI vocal effort scale in the treatment of adductor spasmodic dysphonia. Laryngoscope. 2019 Feb;129(2):448-453. doi: 10.1002/lary.27430. Epub 2018 Oct 12.

Reference Type BACKGROUND
PMID: 30315575 (View on PubMed)

Galluzzi F, Garavello W. The aging voice: a systematic review of presbyphonia. Eur Geriatr Med. 2018 Oct;9(5):559-570. doi: 10.1007/s41999-018-0095-6. Epub 2018 Sep 3.

Reference Type BACKGROUND
PMID: 34654233 (View on PubMed)

Desjardins M, Halstead L, Simpson A, Flume P, Bonilha HS. Respiratory Muscle Strength Training to Improve Vocal Function in Patients with Presbyphonia. J Voice. 2022 May;36(3):344-360. doi: 10.1016/j.jvoice.2020.06.006. Epub 2020 Jul 14.

Reference Type BACKGROUND
PMID: 32680804 (View on PubMed)

Lindstrom E, Ohlund Wistbacka G, Lotvall A, Rydell R, Lyberg Ahlander V. How older adults relate to their own voices: a qualitative study of subjective experiences of the aging voice. Logoped Phoniatr Vocol. 2023 Dec;48(4):163-171. doi: 10.1080/14015439.2022.2056243. Epub 2022 Apr 21.

Reference Type BACKGROUND
PMID: 35446741 (View on PubMed)

Ziegler A, Verdolini Abbott K, Johns M, Klein A, Hapner ER. Preliminary data on two voice therapy interventions in the treatment of presbyphonia. Laryngoscope. 2014 Aug;124(8):1869-76. doi: 10.1002/lary.24548. Epub 2014 Jan 29.

Reference Type BACKGROUND
PMID: 24375313 (View on PubMed)

Guglani I, Sanskriti S, Joshi SH, Anjankar A. Speech-Language Therapy Through Telepractice During COVID-19 and Its Way Forward: A Scoping Review. Cureus. 2023 Sep 6;15(9):e44808. doi: 10.7759/cureus.44808. eCollection 2023 Sep.

Reference Type BACKGROUND
PMID: 37809138 (View on PubMed)

Griffin M, Bentley J, Shanks J, Wood C. The effectiveness of Lee Silverman Voice Treatment therapy issued interactively through an iPad device: A non-inferiority study. J Telemed Telecare. 2018 Apr;24(3):209-215. doi: 10.1177/1357633X17691865. Epub 2017 Feb 1.

Reference Type BACKGROUND
PMID: 28147896 (View on PubMed)

Theodoros DG, Hill AJ, Russell TG. Clinical and Quality of Life Outcomes of Speech Treatment for Parkinson's Disease Delivered to the Home Via Telerehabilitation: A Noninferiority Randomized Controlled Trial. Am J Speech Lang Pathol. 2016 May 1;25(2):214-32. doi: 10.1044/2015_AJSLP-15-0005.

Reference Type BACKGROUND
PMID: 27145396 (View on PubMed)

Titze IR, Palaparthi A, Cox K, Stark A, Maxfield L, Manternach B. Vocalization with semi-occluded airways is favorable for optimizing sound production. PLoS Comput Biol. 2021 Mar 29;17(3):e1008744. doi: 10.1371/journal.pcbi.1008744. eCollection 2021 Mar.

Reference Type BACKGROUND
PMID: 33780433 (View on PubMed)

Belsky MA, Shelly S, Rothenberger SD, Ziegler A, Hoffman B, Hapner ER, Gartner-Schmidt JL, Gillespie AI. Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial. J Voice. 2023 May;37(3):398-409. doi: 10.1016/j.jvoice.2021.02.015. Epub 2021 Mar 16.

Reference Type BACKGROUND
PMID: 33741235 (View on PubMed)

Kempster GB, Gerratt BR, Verdolini Abbott K, Barkmeier-Kraemer J, Hillman RE. Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol. Am J Speech Lang Pathol. 2009 May;18(2):124-32. doi: 10.1044/1058-0360(2008/08-0017). Epub 2008 Oct 16.

Reference Type BACKGROUND
PMID: 18930908 (View on PubMed)

Castro ME, Sund LT, Hoffman MR, Hapner ER. The Voice Problem Impact Scales (VPIS). J Voice. 2024 May;38(3):666-673. doi: 10.1016/j.jvoice.2021.11.011. Epub 2021 Dec 20.

Reference Type BACKGROUND
PMID: 34933795 (View on PubMed)

Rosen CA, Lee AS, Osborne J, Zullo T, Murry T. Development and validation of the voice handicap index-10. Laryngoscope. 2004 Sep;114(9):1549-56. doi: 10.1097/00005537-200409000-00009.

Reference Type BACKGROUND
PMID: 15475780 (View on PubMed)

Related Links

Access external resources that provide additional context or updates about the study.

https://www.phorte.org/

Intervention approach website

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

APP-24-06117

Identifier Type: -

Identifier Source: org_study_id

More Related Trials

Additional clinical trials that may be relevant based on similarity analysis.

Straw Phonation Exercise Program for Pitch Extension
NCT05357222 ACTIVE_NOT_RECRUITING NA