Expiratory Muscle Strength Training in Head and Neck Cancer Survivors With Radiation‐Associated Dysphagia: Results of a Pilot Prospective Trial

BACKGROUND: This single-arm pilot study evaluated feasibility, safety, and outcomes of expiratory muscle strength training (EMST) in head and neck cancer (HNC) with radiation-associated dysphagia (RAD). METHODS: Thirty disease-free HNC survivors (≥ 3 months post-radiotherapy, median 16 months) with evidence of aspiration (penetration-aspiration scale [PAS] ≥ 6) underwent an 8-week EMST protocol (25 repetitions, 5 days/week). Pre- and post-intervention assessments included maximum expiratory pressure (MEP), voluntary cough peak expiratory flow (PEF), videofluoroscopy, and patient-reported outcomes. RESULTS: Twenty-six participants (87%) completed the trial, with high adherence (89% sessions attended; 91% repetitions completed). Adverse events occurred in 8/30 (26.7%). MEP significantly increased by 66% (p < 0.001); PEF showed a non-significant 8% increase (p = 0.23). PAS and IDDSI-Functional Diet Scale scores improved in 38% (p < 0.05). CONCLUSION: EMST is feasible, safe, and improves expiratory and swallowing function in aspirating HNC survivors, warranting randomized trials.