{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:50:04Z","timestamp":1791982204866,"version":"4.4.0"},"reference-count":52,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T00:00:00Z","timestamp":1775865600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>This single\u2010arm pilot study evaluated feasibility, safety, and outcomes of expiratory muscle strength training (EMST) in head and neck cancer (HNC) with radiation\u2010associated dysphagia (RAD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Thirty disease\u2010free HNC survivors (\u2265\u20093\u2009months post\u2010radiotherapy, median 16\u2009months) with evidence of aspiration (penetration\u2010aspiration scale [PAS] \u2265\u20096) underwent an 8\u2010week EMST protocol (25 repetitions, 5\u2009days\/week). Pre\u2010 and post\u2010intervention assessments included maximum expiratory pressure (MEP), voluntary cough peak expiratory flow (PEF), videofluoroscopy, and patient\u2010reported outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty\u2010six 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% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001); PEF showed a non\u2010significant 8% increase (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.23). PAS and IDDSI\u2010Functional Diet Scale scores improved in 38% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>EMST is feasible, safe, and improves expiratory and swallowing function in aspirating HNC survivors, warranting randomized trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hed.70273","type":"journal-article","created":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T08:04:41Z","timestamp":1775894681000},"page":"2638-2649","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expiratory Muscle Strength Training in Head and Neck Cancer Survivors With Radiation\u2010Associated Dysphagia: Results of a Pilot Prospective Trial"],"prefix":"10.1002","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-8373","authenticated-orcid":false,"given":"Beatrice","family":"Manduchi","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla L.","family":"Warneke","sequence":"additional","affiliation":[{"name":"Department of Biostatistics The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha Portwood","family":"Barrow","sequence":"additional","affiliation":[{"name":"Memorial Hermann\u2010Texas Medical Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecilia","family":"Felix\u2010Lusterman","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George A.","family":"Eapen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily K.","family":"Plowman","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery The Ohio State University Wexner Medical Center  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5264-3994","authenticated-orcid":false,"given":"Clifton D.","family":"Fuller","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen Y.","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery The University of Texas MD Anderson Cancer Center  Houston Texas USA"},{"name":"Department of Radiation Oncology The University of Texas MD Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.25412"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29207"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2014.08.009"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.0278"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010022\u201010513\u20106"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010022\u201010521\u20106"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12885\u2010021\u201008826\u20100"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470\u20102045(23)00265\u20106"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2013.05.004"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1590\/1678\u2010775720140132"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100031\u20101271972"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1044\/1058\u20100360(2012\/11\u20100048)"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092\u20104388(2005\/092)"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.03.027"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.26292"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF00417897"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30283"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.34079"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26845"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489418812901"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26397"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1044\/2019_AJSLP\u201019\u201000107"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.08\u20101389"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181fef115"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.24990"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.26986"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010016\u20109710\u20101"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0022\u20103956(75)90026\u20106"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g1687"},{"key":"e_1_2_12_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010008\u20109185\u20109"},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097\u20100142(19960601)77:11<2294::AID\u2010CNCR17>3.0.CO;2\u2010S"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.01.012"},{"issue":"7","key":"e_1_2_12_34_1","first-page":"870","article-title":"The Development and Validation of a Dysphagia\u2010Specific Quality\u2010Of\u2010Life Questionnaire for Patients With Head and Neck Cancer: The M. D. Anderson Dysphagia Inventory","volume":"127","author":"Chen A. Y.","year":"2001","journal-title":"Archives of Otolaryngology \u2013 Head & Neck Surgery"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20602"},{"key":"e_1_2_12_36_1","unstructured":"CDC \u201cNational Health and Nutrition Examination Survey. National Health and Nutrition Examination Survey \u201d 2025 accessed March 11 2026 https:\/\/www.cdc.gov\/nchs\/nhanes\u2010participants\/index.html."},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2023.08.016"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.13274"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.3390\/cancers12113191"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.32583"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2012.00048"},{"key":"e_1_2_12_42_1","unstructured":"Singapore General Hospital \u201cThe Effects of Expiratory Muscle Strength Training (EMST) on Airway Protection and Swallowing in Chronic Dysphagia After Radiation Therapy \u201d clinicaltrials.gov; 2020 accessed July 28 2025 https:\/\/clinicaltrials.gov\/study\/NCT03620084."},{"key":"e_1_2_12_43_1","unstructured":"Ohio State University Comprehensive Cancer Center \u201cThe Impact of Expiratory Muscle Strength Training on Bulbar Function and Well Being of Individuals With Head and Neck Cancer \u201d clinicaltrials.gov; 2019 accessed July 28 2025 https:\/\/clinicaltrials.gov\/study\/NCT03175289."},{"key":"e_1_2_12_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010023\u201010600\u20102"},{"key":"e_1_2_12_45_1","doi-asserted-by":"publisher","DOI":"10.1044\/1092\u20104388(2008\/07\u20100016)"},{"key":"e_1_2_12_46_1","doi-asserted-by":"publisher","DOI":"10.1589\/jpts.29.609"},{"key":"e_1_2_12_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/joor.12382"},{"key":"e_1_2_12_48_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE\u2010172192"},{"key":"e_1_2_12_49_1","doi-asserted-by":"publisher","DOI":"10.1177\/2055217317710829"},{"key":"e_1_2_12_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00455\u2010017\u20109852\u20109"},{"key":"e_1_2_12_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2021.02.015"},{"key":"e_1_2_12_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nmd.2020.07.003"},{"key":"e_1_2_12_53_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE-2005-20407"}],"container-title":["Head &amp; Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70273","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70273","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70273","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:21:19Z","timestamp":1791980479000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70273"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,11]]},"references-count":52,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1002\/hed.70273"],"URL":"https:\/\/doi.org\/10.1002\/hed.70273","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,11]]},"assertion":[{"value":"2025-12-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-31","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-11","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}