Elsevier

Journal of Voice

Volume 37, Issue 2, March 2023, Pages 304.e1-304.e7
Journal of Voice

Presbylarynx: Is It a Sign of the Health Status of the Elderly?

https://doi.org/10.1016/j.jvoice.2020.12.034Get rights and content

Summary

Purpose

Only a full understanding of how different diseases affect the same or different anatomical/functional entities, may provide a clue on how comorbidity should be taken into consideration. The aim of this study was to evaluate the chronic medical illnesses of an elderly population, in order to analyze potential correlation of specific comorbidities with presbylarynx.

Methods

This case-control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by otorhinolaryngology, in a tertiary center, from January to September 2020. The inclusion criteria were ability to report an accurate medical history and ≥65 years of age. The exclusion criteria were neurologic diagnoses, autoimmune disease, history of thoracic or head and neck surgery, cancer, radiotherapy, thyroid pathology, vocal fold mass lesions, acute laryngitis, or vocal fold paralysis. Based on videostroboscopy of the larynx, the patients were subdivided into two main groups: presbylarynx versus no presbylarynx. Health status was assessed by evaluation of chronic medical illnesses (individual diagnoses of chronic conditions plus Charlson comorbidity index [CCI]), functional status (Katz index of independence in activities of daily living and functional Ambulation ambulation classification), and emotional status (Geriatric Depression Scale).

Results

A total of 174 subjects (60 males; 114 females) were included (mean age = 73.99 years; range 65-95 years). Presbylarynx was identified in 71 patients (41%). A statistically significant difference was found concerning diabetes mellitus type 2 (T2DM); P< 0.001), asthma or chronic obstructive pulmonary disease (COPD; P< 0.001), and psychiatric disorder (P< 0.001). The mean score of CCI between “presbylarynx” and “no presbylarynx” groups was statistically different (P= 0.021). Results showed an association between some functional dependence (P< 0.001), and mild or severe depression (P< 0.001) and the presence of presbylarynx.

Conclusions

Presbylarynx may be considered a sign of the health status of the elderly. Based on CCI, It was found that patients with higher probability of 10-year mortality exhibit more endoscopic signs of presbylarynx. It was also found that patients with better scores in functionality scales exhibited less endoscopic findings compatible with presbylarynx. Among chronic medical illnesses, T2DM, asthma, or COPD may be considered risk factors for noticeable endoscopic signs of presbylarynx.

Section snippets

INTRODUCTION

Population aging is one of the challenges that worldwide healthcare systems face in the 21st century, and dysphonia is one of the common but undertreated health problems of the elderly.1,2 The incidence of voice disorders in the geriatric population is estimated to be from 12% to 35%.3, 4, 5, 6, 7, 8 Among the various causes of geriatric dysphonia, presbylarynx is attracting considerable attention.3, 4, 5, 6, 7,9

Presbylarynx can be defined as the age-related morphological changes in the larynx

MATERIALS AND METHODS

This study was approved by the local ethical committee and was carried out in accordance with the guidelines of the Declaration of Helsinki on human studies.

This case-control, prospective, observational, and cross-sectional study was carried out on a total of 194 consecutive subjects observed by otorhinolaryngology, in a tertiary center, from January to September 2020. All of the patients were evaluated by the same otorhinolaryngologist, and a comprehensive medical history was obtained from

Study population

The study population included a total of 174 Caucasian subjects (60 males; 114 females), and mean age was 73.99 years (SD = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%) with no statistically significant predilection by gender (P= 0.254). The mean age of the patients with presbylarynx was statistically higher (76.29 years old; SD = 6.28; P< 0.001) than patients without presbylarynx.

Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%)

DISCUSSION

The normal aging process affects human function broadly and profoundly, including voice.2 Thus, studies of voice changes in the elderly are extremely relevant because of the expansion of the aging population, and the impact of dysphonia on the emotional and social function of older adults.24 However, elderly patients generally have multiple medical problems, and no single medical issue can be evaluated and treated in isolation.25

In population studies, the prevalence of comorbidities and number

CONCLUSIONS

Our study found that elderly patients with T2DM, asthma and/or chronic obstructive lung disease, and psychiatric disorders all showed a statistically significant increase in endoscopic evidence of anatomical changes compatible with presbylarynx than their study cohorts without these chronic medical problems. The inverse also held true for those patients having a lower probability of mortality within 10 years (less presbylarynx findings) and patients with better scores on health functionality

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

COMPLIANCE WITH ETHICAL STANDARDS

Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent: Informed consent was obtained from all individual participants included in the study.

FINANCIAL DISCLOSURE

The authors declare that they have no financial disclosure to declare.

References (29)

  • S Takano et al.

    Clinical analysis of presbylarynx-vocal fold atrophy in the elderly individuals

    Auris Nasus Larynx

    (2010)
  • P Woo et al.

    Dysphonia in the aging: physiology versus disease

    Laryngoscope

    (1992)
  • N Roy et al.

    Epidemiology of voice disorders in the elderly: preliminary findings

    Laryngoscope

    (2007)
  • K. Kendall

    Presbyphonia: a review

    Curr Opin Otolaryngol Head Neck Surg

    (2007)
  • Cited by (2)

    • Presbylarynx: How Easy Is It To Recognize The Aging Signs? A Prospective Study With Inter- And Intra-Rater Reliability In Laryngoscopic Evaluation

      2022, Journal of Voice
      Citation Excerpt :

      Finally, and as expected, Presbylarynx was mostly identified in laryngoscopic recordings of subjects older than 65 years old, corroborating the correlation between aging signs of the larynx and older ages. Presbylarynx results from the effect of the aging process that occurs continuously and differently among different individuals, with factors such as health status and body muscle mass having been proven to influence laryngeal aging.14,15 Presbylarynx is, therefore, an entity that differs among elderly patients and there isn't a specific age from which signs of presbylarynx are observed, nor is it present in all elderly patients.

    View full text