An interventional study of EMST150 in Cleft Palate, Tube Disorders Eustachian and Velopharyngeal Incompetence Due to Cleft Palate, sponsored by Noel Jabbour. Terminated at 1 site in United States. Open to participants aged 6 Years to 17 Years. Per ClinicalTrials.gov, last updated 2023-06-23.
Sponsored by Noel Jabbour · Not applicable, Interventional, and Treatment
Elevation of the soft palate (the soft part of the roof of the mouth) during swallowing helps the Eustachian tube to open and keep the ear healthy. (The Eustachian tube is the normal tube running from the middle ear to the back of the nose and throat). When the soft palate does not move enough (due to a history of cleft palate or for unknown reasons), this can lead to speech problems. Also, because the Eustachian tube is not opening enough, fluid can accumulate in the middle ear, which requires treatment with ear tubes. The goal of this research study is to determine if soft palate exercises will help improve the ability of the soft palate to close the area between the throat and nose, like it is supposed to during speech and swallowing, and if this improves Eustachian tube opening.
This trial will look at the feasibility and effect of device-assisted soft palate exercises for the treatment of chronic Eustachian tube (ET) dysfunction (ETD) in older children still experiencing middle-ear disease. Children with or without cleft palate (CP) with ventilation tubes (VTs) will be evaluated for the function of the soft palate and the ET. Subjects with active muscular ETD and inadequate soft palate closure will be prescribed soft palate strengthening exercises for at least 2 months. The objective of the study is to demonstrate the effect of exercises on soft palate closure and ETF. This pilot study will enroll 30 children between ages 6-17 years with VTs or post-VT extrusion tympanic membrane (TM) perforations. All 30 children will have ETD, with active muscular dysfunction. 15 subjects will have a history of cleft palate (CP) and 15 no history of CP. Subjects will undergo history, physical examination including an ENT exam, video-otoscopy and ET function testing which may include Forced Response Test (FRT), Inflation-Deflation Test (IDT) and Tubomanometry. They will also undergo evaluations for swallow, speech and soft palate function. Enrolled children will then receive instruction on the use their EMST150 exercise device. This device will be used daily for at least 2 months. Subjects will undergo full evaluations for ET function and velopharyngeal incompetence after the 2-month treatment and will then discontinue the use of devices for at least 2 months. After this time, the same testing will be done. Weekly phone calls/emails/texts from study staff will encourage use of the devices as prescribed.
The following secondary outcome measures were part of the original study protocol but were eliminated after the start of the COVID-19 pandemic because the tests involved blowing maneuvers and risk of aerosolization. The protocol was modified to only include ETF tests that were necessary to achieve the goals of the study and that were safe for the participants.
'Velopharyngeal pressure after 2 months of exercise compared with baseline' 'Velopharyngeal pressure after 2 months of rest compared with baseline' 'Duration of velopharyngeal closure after 2 months of exercise compared with baseline' 'Duration of velopharyngeal closure after 2 months of rest compared with baseline' 'Ability to maintain velopharyngeal closure after 2 months of exercise compared with baseline' 'Ability to maintain velopharyngeal closure after 2 months of rest compared with baseline' 'Overall success in velopharyngeal closure after 2 months of exercise compared with baseline' 'Overall success in velopharyngeal closure following 2 months of rest compared with baseline'
The following other pre-specified outcome measures were removed for the same reason:
'Velopharyngeal pressure after 2 months of rest compared with pressure immediately following 2 months of exercise' 'Duration of velopharyngeal closure after 2 months of rest compared with pressure immediately following 2 months of exercise' 'Ability to maintain velopharyngeal closure after 2 months of rest compared with ability immediately following 2 months of exercise' 'Overall success in velopharyngeal closure following 2 months of rest compared with success immediately following 2 months of exercise'
'Eustachian tube function after 2 months of rest compared with function immediately following 2 months of exercise' was moved from an other pre-specified outcome measure to a secondary outcome measure due to its similar level of importance to the other secondary outcome measures.
Pressure chamber results were removed from outcome measures because they were unable to be obtained safely during the COVID-19 pandemic.
131 studies on the registry are indexed under Cleft Palate; 36 are open to participants now.
This study's enrollment of 11 is below the median of 40 across 85 interventional studies indexed under Cleft Palate.
Browse Cleft Palate studies →Noel Jabbour is the lead sponsor of 2 studies on the registry; 1 is open to participants now.
Counted across the registry records on this site, refreshed daily.
Exclusion Criteria:
Subjects with or without cleft palate will use the EMST150 2 times a day for 8 weeks.
Device: EMST150
The EMST150 consists of a handheld plastic tube with a mouthpiece on one end and an adjustable valve on the other end. Your child will close his/her lips around the mouthpiece and breathe out against resistance. The EMST150 will be adjusted to the point where airflow stops. Each day, your child will blow into the EMST150 5 sets of 5 times with a 10-15 second rest between each use and a 1-2 minute rest between each set of 5. You will adjust the resistance of the device each week, take a picture of the device settings, and document exercise sets performed in an exercise diary. These exercises will be performed twice in each nostril 2 times a day until your child's next visit at the MEPL (at least 8 weeks). Each session should take approximately 10-15 minutes, for a total of 30 minutes per day.
Also known as: Expiratory Muscle Strength Trainer 150
Eustachian Tube Function at 2 Months
Percent change in middle ear pressure equilibrated during the inflation-deflation test at 2 months
Time frame: 2 months
Eustachian Tube Function at 4 Months
Percent change in middle ear pressure equilibrated during the inflation-deflation test at 4 months
Time frame: 4 months
Signs of Submucous Cleft Palate Following 2 Months of Exercise Compared With Baseline
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Time frame: Baseline and 2 months
Signs of Submucous Cleft Palate Following 2 Months of Rest Compared With Baseline
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Time frame: Baseline and 4 months
Signs of Submucous Cleft Palate Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Time frame: 2 months and 4 months
Perceptual Speech Symptoms of Velopharyngeal Dysfunction Following 2 Months of Exercise Compared With Baseline
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Time frame: Baseline and 2 months
Perceptual Speech Symptoms of Velopharyngeal Dysfunction Following 2 Months of Rest Compared With Baseline
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Time frame: Baseline and 4 months
Perceptual Speech Symptoms of Velopharyngeal Dysfunction Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Time frame: 2 months and 4 months
Eustachian Tube Function Observed During Maneuvers Following 2 Months of Exercise Compared With Baseline
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 2 months
Residual Middle Ear Pressure Observed During Maneuvers Following 2 Months of Exercise Compared With Baseline
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 2 months
Eustachian Tube Function Observed During Maneuvers Following 2 Months of Rest Compared With Baseline
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 4 months
Residual Middle Ear Pressure Observed During Maneuvers Following 2 Months of Rest Compared With Baseline
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 4 months
Eustachian Tube Function Observed During Maneuvers Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: 2 months and 4 months
Residual Middle Ear Pressure Observed During Maneuvers Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: 2 months and 4 months
Velopharyngeal Function Observed During Maneuvers Following 2 Months of Exercise Compared With Baseline
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 2 months
Residual Nasopharyngeal Pressures Observed During Maneuvers Following 2 Months of Exercise Compared With Baseline
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 2 months
Velopharyngeal Function Observed During Maneuvers Following 2 Months of Rest Compared With Baseline
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 4 months
Residual Nasopharyngeal Pressures Observed During Maneuvers Following 2 Months of Rest Compared With Baseline
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: Baseline and 4 months
Velopharyngeal Function Observed During Maneuvers Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: 2 months and 4 months
Residual Nasopharyngeal Pressures Observed During Maneuvers Following 2 Months of Rest Compared With Immediately Following 2 Months of Exercise
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Time frame: 2 months and 4 months
| Milestone | EMST150 | EMST150 + Eustachi |
|---|---|---|
| Started | 8 | 3 |
| Visit 2 | 7 | 1 |
| Visit 3 | 4 | 0 |
| Completed | 4 | 0 |
| Not completed | 4 | 3 |
| Withdrew: Adverse event | 1 | 0 |
| Withdrew: Lost to follow-up | 2 | 1 |
| Withdrew: Covid-19 restrictions | 1 | 2 |
Percent change in middle ear pressure equilibrated during the inflation-deflation test at 2 months
| percent change in middle ear pressure | EMST150 | EMST150 + Eustachi |
|---|---|---|
| Inflation Test | 12.0 (10.4 to 65.8) | 83.6 (77.5 to 89.7) |
| Deflation Test | 8.5 (4.7 to 10.4) | 44.0 (33.2 to 54.8) |
Percent change in middle ear pressure equilibrated during the inflation-deflation test at 4 months
| percent change in middle ear pressure | EMST150 |
|---|---|
| Inflation Test | 64.1 (23.0 to 87.2) |
| Deflation Test | 6.5 (6.0 to 9.9) |
Percent change in middle ear pressure equilibrated during the inflation-deflation test at 4 months
| percent change in middle ear pressure | EMST150 |
|---|---|
| Inflation Test | 64.1 (23.0 to 87.2) |
| Deflation Test | 6.5 (6.0 to 9.9) |
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Results for this outcome have not been posted.
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Results for this outcome have not been posted.
Presence or absence of dimpling anterior to the uvula, soft palate vaulting, midline groove, translucent midline, or visible notch in posterior hard palate observed on palate activation during video-analysis
Results for this outcome have not been posted.
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Results for this outcome have not been posted.
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Results for this outcome have not been posted.
Perceptual symptoms of velopharyngeal incompetence measured using the Pittsburgh Weighted Speech Score, on a scale of 0-23, with ≥7 indicating likely velopharyngeal incompetence
Results for this outcome have not been posted.
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Maximum middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual middle ear pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Maximum nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Residual nasopharyngeal pressures achieved during Toynbee, Valsalva, Sniffing, Dive maneuver and the Patulous Test in daPa
Results for this outcome have not been posted.
Collected over 8 months. Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| EMST150 | 0/8 (0%) | 0/8 (0%) | 6/8 (75%) |
| EMST150 + Eustachi | 0/3 (0%) | 0/3 (0%) | 3/3 (100%) |
| Event | EMST150 | EMST150 + Eustachi |
|---|---|---|
| Upper Respiratory InfectionGeneral disorders | 4/8 | 3/3 |
| EpistaxisGeneral disorders | 1/8 | 2/3 |
| OtalgiaEar and labyrinth disorders | 1/8 | 2/3 |
| Gastrointestinal Discomfort or InfectionGeneral disorders | 0/8 | 2/3 |
| Patulous Eustachian TubeEar and labyrinth disorders | 1/8 | 0/3 |
| Acute Otitis MediaEar and labyrinth disorders | 1/8 | 0/3 |
| COVID-19General disorders | 1/8 | 0/3 |
| Allergic Rhinitis SymptomsGeneral disorders | 1/8 | 0/3 |
| Bloody OtorrheaEar and labyrinth disorders | 1/8 | 0/3 |
For Eustachian Tube Function, analysis was performed on ears from which primary outcome data were available. Data were analyzed from 7 ears from 5 participants in the EMST150 group and 2 ears from 1 participant in the EMST150 + Eustachi group.
| Age, Continuous(years) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| Median | 10.9 (9.9 to 14.8) | 9.8 (9.7 to 15.2) | 10.6 (9.7 to 15.2) |
| Age, Customized(Participants) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| <10 years old | 2 | 2 | 4 |
| 10-12 years old | 3 | 0 | 3 |
| >12 years old | 3 | 1 | 4 |
| Sex: Female, Male(Participants) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| Female | 5 | 3 | 8 |
| Male | 3 | 0 | 3 |
| Ethnicity (NIH/OMB)(Participants) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| Hispanic or Latino | 0 | 0 | 0 |
| Not Hispanic or Latino | 7 | 3 | 10 |
| Unknown or Not Reported | 1 | 0 | 1 |
| Race (NIH/OMB)(Participants) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 |
| Asian | 0 | 0 | 0 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 |
| Black or African American | 0 | 0 | 0 |
| White | 7 | 3 | 10 |
| More than one race | 1 | 0 | 1 |
| Unknown or Not Reported | 0 | 0 | 0 |
| Region of Enrollment(participants) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| United States | 8 | 3 | 11 |
| Eustachian Tube Function(percent change in middle ear pressure) | EMST150 | EMST150 + Eustachi | Total |
|---|---|---|---|
| Inflation Test | 14.9 (9.6 to 50.8) | 81.2 (75.1 to 87.3) | 30.3 (14.8 to 67.5) |
| Deflation Test | 5.7 (4.0 to 17.9) | 65.5 (30.5 to 100.5) | 10.7 (4.7 to 21.0) |
Documents are hosted by the registry — open the source record to download them.
Plan to share: Yes — Individual participant data (IPD) may be shared, after de-identification, with researchers who provide a methodologically sound proposal. IPD to be shared will include that necessary to achieve the aims in the approved proposal.
Supporting information: Study protocol, Sap, Icf, Csr, Analytic code
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