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

Abstract

Purpose: To determine if recognition of presbylarynx is easy and straightforward.

Method: First, a systematic review regarding the structural features of the geriatric larynx through laryngostroboscopy was performed, and its results were presented to the raters in an educational session. Then, video recordings of rigid laryngostroboscopies were randomly selected and presented to a panel of otorhinolaryngologists. Intra- and inter-rater reliability were determined.

Results: Based on the main findings of the systematic review, raters were invited to consider the diagnosis of presbylarynx when one or more of the following endoscopic signs were present: atrophic vocal folds (VF), VF bowing, prominence of vocal processes, or spindle-shaped glottal gap. Twenty otorhinolaryngologists from five tertiary hospitals participated in this study (residents and specialists). Among 300 evaluations performed (15 video recordings x 20 raters), the intra-rater agreement was 93.0%. The Cohen´s Kappa for intra-rater reliability was higher than 0.600 for all the raters except for two residents. Cohen´s Kappa was higher among specialists (0.893) than among residents (0.826). The highest Cohen´s Kappa was registered for evaluations performed by specialists with differentiation in laryngology (0.933). Presbylarynx was identified mostly in laryngostroboscopic recordings of subjects older than 65 years.

Conclusion: we consider the answer to "Presbylarynx: How easy is it to recognize the aging signs" to be "After education on signs of presbylarynx, it is easy." This answer is supported by the high rate of intra- and inter-rater agreement, in a blinded and randomized presentation of laryngostroboscopic recordings, and by the fact that the diagnosis of presbylarynx was mostly attributed to videos regarding subjects aged 65 years and older. It proves that is not difficult to recognize aging signs in the larynx. Thus, in the future, more education regarding presbylarynx and further studies to improve criteria for its diagnosis may improve the management of the aging voice.

Keywords: Aging; Elderly; Presbylarynx; Vocal atrophy.