title: Independent exercise for glottal incompetence to improve vocal problems and prevent aspiration pneumonia in the elderly: a randomized controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of a self-controlled vocal exercise in elderly people with glottal closure insufficiency.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  gov Identifier-UMIN000015567.
authors.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.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Fujimaki
authors.affiliation: 1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Tsunoda
authors.affiliation: 1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: Rika
authors.initials: R
authors.lastname: Kobayashi
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Chong
authors.initials: C
authors.lastname: Tonghyo
authors.affiliation: 4 Department of Otolaryngology, National Hospital Organization Nagasaki Medical Center, Tokyo, Japan.
authors.forename: Fujinobu
authors.initials: F
authors.lastname: Tanaka
authors.affiliation: 5 Department of Otolaryngology, National Hospital Organization Kobe Medical Center, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: 6 Miura ENT Clinic, Tokyo, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Numata
authors.affiliation: 7 Department of Otolaryngology, Sagamihara National Hospital, Tokyo, Japan.
authors.forename: Toyota
authors.initials: T
authors.lastname: Ishii
authors.affiliation: 8 Department of Otolaryngology, Hirosaki National Hospital, Tokyo, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kuroda
authors.affiliation: 9 Department of Otolaryngology, National Mie Hospital, Tokyo, Japan.
authors.forename: Sawako
authors.initials: S
authors.lastname: Masuda
authors.affiliation: 10 Department of Otolaryngology, National Sendai Medical Center, Tokyo, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Hashimoto
authors.affiliation: 11 Department of Otolaryngology, National Hospital Organization Nagoya Medical Center, Tokyo, Japan.
authors.forename: Hayato
authors.initials: H
authors.lastname: Misawa
authors.affiliation: 12 Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Shindo
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mori
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Mori
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Uchiyama
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yuichirou
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Hironobu
authors.initials: H
authors.lastname: Hamaya
authors.affiliation: 3 Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Funatsuki
authors.affiliation: 9 Department of Otolaryngology, National Mie Hospital, Tokyo, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Usui
authors.affiliation: 12 Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
authors.forename: Ikuno
authors.initials: I
authors.lastname: Ito
authors.affiliation: 12 Department of Rehabilitation, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Hamada
authors.affiliation: 13 Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Shindo
authors.affiliation: 13 Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tokumaru
authors.affiliation: 14 Department of Neurology National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Morita
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Rumi
authors.initials: R
authors.lastname: Ueha
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Nito
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Shu
authors.initials: S
authors.lastname: Kikuta
authors.affiliation: 1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: Sotaro
authors.initials: S
authors.lastname: Sekimoto
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Kondo
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Sakamoto
authors.affiliation: 1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Itoh
authors.affiliation: 2 Department of Otolaryngology, University of Tokyo Graduate School of Medicine, Tokyo, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamasoba
authors.affiliation: 1 Department of Artificial Organs and Medical Device Creation, National Institute of Sensory Organs, Tokyo, Japan.
authors.forename: Sumio
authors.initials: S
authors.lastname: Matsumoto
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation*; D015444:Exercise / Q000502:physiology*; D005931:Glottis / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D007828:Laryngoscopy / Q000379:methods; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data; D011015:Pneumonia, Aspiration / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D020127:Recovery of Function; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome
keywords: Aging; aspiration pneumonia; glottal closure insufficiency; randomized controlled trial; self-controlled vocal exercise