Proposed Topic (Most preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Proposed Topic (Second preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Cheng SW(1), Leung KHV(1), Mok KCJ(1), Yeung KW(1), Wong SYI(2), Lam YL(2), Ip KM(2), Lok YW(2), Wong ACL(1)
Affiliation :
(1)Department of Ear, Nose & Throat, Tuen Mun Hospital, (2)Department of Speech Therapy, Tuen Mun Hospital
Introduction :
Nasopharyngeal carcinoma (NPC) is endemic in Southern China. NPC is radiosensitive and therefore radiation therapy remains the mainstay of treatment. Dysphagia and chronic aspiration are common post-irradiation complications in NPC survivors. Efficacies across different swallowing rehabilitation program were heterogeneous. Expiratory Muscle Strength Training (EMST) is a simple device-driven exercise therapy for swallowing training. EMST is thought to improve airway protection by increasing subglottic expiratory pressure generating forces, translating to a stronger cough to clear foreign bodies in the airway or improving airway closure by exercising the suprahyoid muscles.
Objectives :
This study investigates the effectiveness of EMST in a group of post-irradiated NPC patients. We hypothesized that improvement in expiratory pressure, which is important for cough strength, and swallowing function (penetration, aspiration and pharyngeal residue) can be achieved by strengthening expiratory muscles with EMST in NPC survivors.
Methodology :
This prospective cohort, including twelve patients with previous irradiation for NPC and with swallowing disturbance, was performed between 2019 and 2021 in Department of Ear, Nose & Throat, Tuen Mun Hospital. Patients were trained with EMST for 8 weeks. Non-parametric analyses examined effects of EMST on primary outcome, maximum expiratory pressure. Secondary outcomes were measured with Penetration-aspiration scale, Yale pharyngeal residue severity rating scale by flexible endoscopic evaluation of swallowing, and Eating Assessment Tool (EAT-10) and M.D. Anderson Dysphagia Inventory questionnaire.
Result & Outcome :
Twelve patients, with a mean (SD) age of 64.3 (8.2) were recruited. There was no patient dropout with 88.9% overall compliance of training. Maximum expiratory pressure
improved by 41% (median 94.5 to 133.5 cmH2O, p = 0.003). There was reduction in Penetration-aspiration scale with thin liquid (median 4 to 3, p = 0.026), and in YPRSRS at pyriform fossa with mildly thick liquid (p = 0.021) and at vallecula with thin liquid (p = 0.034), mildly thick liquid (p = 0.014) and pureed meat congee (p = 0.016). Questionnaire scores did not significantly change statistically. In conclusion, EMST is an easy-to-use and effective exercise therapy to improve airway safety and swallowing function in post-irradiated NPC survivors.
