Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial

Author:

Fujimaki Yoko12,Tsunoda Koichi1,Kobayashi Rika1,Tonghyo Chong3,Tanaka Fujinobu4,Kuroda Hiroyuki5,Numata Tsutomu6,Ishii Toyota7,Kuroda Reiko8,Masuda Sawako9,Hashimoto Sho10,Misawa Hayato11,Shindo Naoko12,Mori Takahiro3,Mori Hiroko3,Uchiyama Naoki3,Kamei Yuichirou3,Tanaka Masashi3,Hamaya Hironobu3,Funatsuki Shingo3,Usui Satoko9,Ito Ikuno12,Hamada Kohei12,Shindo Akihito13,Tokumaru Yutaka13,Morita Yoko14,Ueha Rumi2,Nito Takaharu2,Kikuta Shu2,Sekimoto Sotaro1,Kondo Kenji2,Sakamoto Takashi2,Itoh Kenji1,Yamasoba Tatsuya2,Matsumoto Sumio1,

Affiliation:

1. Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan

2. Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan

3. Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

4. Department of Otolaryngology, National Hospital Organization Nagasaki Medical Center, Tokyo, Japan

5. Department of Otolaryngology, National Hospital Organization Kobe Medical Center, Tokyo, Japan

6. Miura ENT Clinic, Tokyo, Japan

7. Department of Otolaryngology, Sagamihara National Hospital, Tokyo, Japan

8. Department of Otolaryngology, Hirosaki National Hospital, Tokyo, Japan

9. Department of Otolaryngology, National Mie Hospital, Tokyo, Japan

10. Department of Otolaryngology, National Sendai Medical Center, Tokyo, Japan

11. Department of Otolaryngology, National Hospital Organization Nagoya Medical Center, Tokyo, Japan

12. Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, Tokyo, Japan

13. Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan

14. Department of Neurology National Hospital Organization Tokyo Medical Center, Tokyo, Japan

Abstract

Objectives: To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency. Design: Parallel-arm, individual randomized controlled trial. Methods: Patients who visited one of 10 medical centers under the National Hospital Organization group in Japan for the first time, aged 60 years or older, complaining of aspiration or hoarseness, and endoscopically confirmed to have glottal closure insufficiency owing to vocal cord atrophy, were enrolled in this study. They were randomly assigned to an intervention or a control group. The patients of the intervention group were given guidance and a DVD about a self-controlled vocal exercise. The maximum phonation time which is a measure of glottal closure was evaluated, and the number of patients who developed pneumonia during the six months was compared between the two groups. Results: Of the 543 patients enrolled in this trial, 259 were allocated into the intervention group and 284 into the control; 60 of the intervention group and 75 of the control were not able to continue the trial. A total of 199 patients (age 73.9 ±7.25 years) in the intervention group and 209 (73.3 ±6.68 years) in the control completed the six-month trial. Intervention of the self-controlled vocal exercise extended the maximum phonation time significantly ( p < 0.001). There were two hospitalizations for pneumonia in the intervention group and 18 in the control group, representing a significant difference ( p < 0.001). Conclusion: The self-controlled vocal exercise allowed patients to achieve vocal cord adduction and improve glottal closure insufficiency, which reduced the rate of hospitalization for pneumonia significantly. Clinical Trial.gov Identifier-UMIN000015567

Funder

the National Hospital Organization Network Joint Research Fund

Publisher

SAGE Publications

Subject

Rehabilitation,Physical Therapy, Sports Therapy and Rehabilitation

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