Stratifying Presbylarynx: Characterization of its Three Types

Abstract

Objectives: To describe the clinical characteristics of each type of glottal configuration proposed in a classification that allows stratifying presbylarynx into three types: Type 0: there is no significant morphological alteration in glottal configuration. Type 1: two or more of the following endoscopic signs are present: atrophic vocal folds, vocal fold bowing, prominence of vocal processes, supraglottal hyperactivity, decreased amplitude (vocal fold edge stiffness without evidence of vocal post-traumatic scar), and tremor of laryngeal structures. Type 2: elderly patients with type 1 plus glottal insufficiency.

Methods: Prospective, observational, and cross-sectional study. Data regarding age, gender, type of glottal configuration, self-assessment regarding vocal complaints, as well as acoustic and audio-perceptive examination were collected.

Results: The study population included 306 subjects (180 females), and the mean age was 73.85. Type 0 was the most frequent (61%). A statistically significant association was found between type 0 and female subjects, as well as type 2 and male subjects. The mean age of the patients with type 0 was statistically lower than the mean age of the patients with type 1 or type 2. The mean score of self-assessment questionnaires of patients with type 2 was statistically higher than the mean score registered for patients with type 0 and type 1. The mean score of Jitter, Shimmer, and HNR in type 2 were statistically higher than in type 0 or type 1 (P < 0.05). The mean score of Maximum Phonation Time in type 2 was statistically lower than in type 0 or 1 (P < 0.001). Based on vocal complaints, 115 subjects (38%) had presbyphonia (46 males; 69 females), and the mean age was 75.97 years (SD = 6.98; range 65 - 97). Among subjects without presbyphonia (n = 191), type 0 was the most frequent (84%), followed by type 1 (15%) and type 2 (1%). Among subjects with presbyphonia (n = 115), type 1 was the most frequent (58%), followed by type 0 (23%) and type 2 (19%).

Conclusions: This study presented the clinical characterization of a classification that allows stratifying endoscopic laryngeal signs in elderly patients with presbyphonia. We believe this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.

Keywords: Aging; Elderly; Presbylarynx; Vocal atrophy.