Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Heather Shaw Bonilha

Second Advisor

Lucinda Halstead

Third Advisor

Annie Simpson

Fourth Advisor

Patrick Flume

Fifth Advisor

Zoher F. Kapasi


Background: Presbyphonia is an age-related voice disorder characterized by vocal fold atrophy, and its effects on voice are potentially compounded by declines in respiratory function. We assessed: 1) the relationships between respiratory and voice function; 2) the effect of adding respiratory exercises to voice therapy; and 3) the impact of baseline respiratory function on the response to therapy in patients with presbyphonia. Methods: Twenty-one participants underwent respiratory and voice assessments, from which relationships were drawn. Ten of these participants were blocked-randomized to receive either voice exercises only, or voice exercises combined with inspiratory muscle strength training or expiratory muscle strength training, for a duration of four weeks. Results: FVC, FEV1, and MEP had an impact on phonation physiology through their effect on aerodynamic resistance and vocal fold pliability. Percent predicted values of FVC and FEV1 were strong predictors of perceived voice handicap. IMST induced the largest improvements in perceived handicap, and a lower baseline respiratory function was associated with a greater improvement, regardless of the intervention received. Conclusion: Respiratory function impacts voice and the response to behavioral voice therapy. Adding IMST to voice exercises improves self-reported outcomes even in patients with a normal respiratory function.


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