Poster Presentation Joint Scientific Meeting of the Australian & NZ Head & Neck Cancer Society & NZ Association of Plastic Surgeons

The use of expiratory muscle strength training (EMST) in the management of dysphagia and aspiration in the head and neck (H&N) cancer population – experiences from Prince of Wales Hospital. (1410)

Emma Stradling 1 , Rachelle Robinson 1 , Molly Barnhart 1 , Robert Smee 1
  1. Prince of Wales Hospital, Randwick, NSW, Australia


Treatment for H&N cancer requires a complex, multimodal approach to offer the best prospect of long-term cure. There can however be significant functional costs and dysphagia is a well-known and difficult to manage sequale of treatment (Nguyen et al 2005)

A 2019 feasibility study by the speech pathology department at POWH demonstrated the potential merit of EMST in the management of chronic dysphagia. This study aimed to continue to evaluate this treatment approach.


Patients were selected and consented for inclusion in the study during 2020. Baseline and post treatment measures were captured including severity of penetration aspiration (PAS), functional oral intake scores (FOIS), Dysphagia Outcome Severity Score (DOSS), maximum expiratory pressure (MEP) and a modified quality of life questionnaire (Swal-QOL).

Patients participated in an 8-week therapy programme using the EMST device under the guidance of a speech pathologist.  Some aspects of the protocol were modified due to COVID 19.


20 patients commenced the programme although 2 did not complete the full 8 weeks. Results demonstrated improvement in several of the outcome measures collected including PAS, FOIS and quality of life scores.


EMST appears to be a useful tool in addressing swallow safety in chronic dysphagia in the H&N neck cancer population. Severity and frequency of aspiration appear to be reduced although impact on swallow efficiency is unclear.  It is easy to implement with a relatively low therapist/patient burden both n terms of time and complexity.  Whilst early experiences are positive, there is an ongoing need for further larger studies to allow more robust evaluation of its efficacy.

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