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The aging voice: a systematic review of presbyphonia

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Abstract

Purpose

To perform a comprehensive review of the literature regarding presbyphonia.

Methods

We searched PUBMED through a combination of MeSH terms for articles published in the English language concerning presbyphonia.

Results

Presbyphonia identifies vocal changes due to anatomical and physiological changes of the larynx occurring during the aging process. It affects about 10–20% of elderly and could negatively impact on their quality of life. The diagnosis of presbyphonia is typically a diagnosis of exclusion made in absence of other laryngeal disease with a characteristic clinic of aging voice and an instrumental pattern of presbylarynx. The treatme nt of choice for presbyphonia is speech therapy that significantly improves voice performances. In case of failure, surgical therapy should be proposed in selected patients although evidence of its benefit is scanty.

Conclusions

The reviewed evidence regarding aging voice has shown that presbyphonia is considered a clinical entity that could impact the quality of life in elderly. Speech therapy is effective for improving voice performances.

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References

  1. Pontes P, Yamasaki R, Behlau M (2006) Morphological and functional aspects of the senile larynx. Folia Phoniatr Logop 58(3):151–158

    Article  PubMed  Google Scholar 

  2. Takano S, Kimura M, Nito T, Imagawa H, Sakakibara K, Tayama N (2010) Clinical analysis of presbylarynx vocal fold atrophy in elderly individuals. Auris Nasus Larynx. https://doi.org/10.1016/j.anl.2009.11.013

    Article  PubMed  Google Scholar 

  3. Bloch I, Behrman A (2001) Quantitative analysis of videostroboscopic images in presbylarynges. Laryngoscope 111(11 Pt 1):2022–2027

    Article  CAS  PubMed  Google Scholar 

  4. Vaca M, Mora E, Cobeta I (2015) The aging voice: influence of respiratory and laryngeal changes. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599815592373

    Article  PubMed  Google Scholar 

  5. Bielamowicz S (2004) Aging voice or vocal fold paresis: what can I do about it? Arch Otolaryngol Head Neck Surg 130(9):1114–1116

    Article  PubMed  Google Scholar 

  6. Gregory ND, Chandran S, Lurie D, Sataloff RT (2012) Voice disorders in the elderly. J Voice. https://doi.org/10.1016/j.jvoice.2010.10.024

    Article  PubMed  Google Scholar 

  7. Ferrucci L, Giallauria F, Guralnik JM (2008) Epidemiology of aging. Radiol Clin N Am. https://doi.org/10.1016/j.rcl.2008.07.005

    Article  PubMed  Google Scholar 

  8. Davids T, Klein AM, Johns MM III (2012) Current dysphonia trends in patients over the age of 65: is vocal atrophy becoming more prevalent? Laryngoscope. https://doi.org/10.1002/lary.22397

    Article  PubMed  Google Scholar 

  9. Kandoğan T, Olgun L, Gültekin G (2003) Causes of dysphonia in patients above 60 years of age. Kulak Burun Bogaz Ihtis Derg 11(5):139–143

    PubMed  Google Scholar 

  10. Golub JS, Chen PH, Otto KJ, Hapner E, Johns MM III (2006) Prevalence of perceived dysphonia in a geriatric population. J Am Geriatr Soc 54(11):1736–1739

    Article  PubMed  Google Scholar 

  11. Crawley BK, Dehom S, Thiel C, Yang J, Cragoe A, Mousselli I et al (2018) Assessment of clinical and social characteristics that distinguish presbylaryngis from pathologic presbyphonia in elderly individuals. JAMA Otolaryngol Head Neck Surg. https://doi.org/10.1001/jamaoto.2018.0409

    Article  PubMed  Google Scholar 

  12. Roy N, Stemple J, Merrill RM, Thomas L (2007) Epidemiology of voice disorders in the elderly: preliminary findings. Laryngoscope 117(4):628–633

    Article  PubMed  Google Scholar 

  13. Sato K, Hirano M, Nakashima T (2002) Age-related changes of collagenous fibers in the human vocal fold mucosa. Ann Otol Rhinol Laryngol 111(1):15–20

    Article  PubMed  Google Scholar 

  14. Ohno T, Hirano S, Rousseau B (2009) Age-associated changes in the expression and deposition of vocal fold collagen and hyaluronan. Ann Otol Rhinol Laryngol 118(10):735–741

    Article  PubMed  PubMed Central  Google Scholar 

  15. Branco A, Todorovic Fabro A, Gonçalves TM, Garcia Martins RH (2015) Alterations in extracellular matrix composition in the aging larynx. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599814562727

    Article  PubMed  Google Scholar 

  16. Gonçalves TM, Dos Santos DC, Pessin AB, Martins RH (2016) Scanning electron microscopy of the presbylarynx. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599816637081

    Article  PubMed  Google Scholar 

  17. Ximenes Filho JA, Tsuji DH, do Nascimento PH, LU Sennes (2003) Histologic changes in human vocal folds correlated with aging: a histomorphometric study. Ann Otol Rhinol Laryngol 112(10):894–898

    Article  PubMed  Google Scholar 

  18. Kosztyla-Hojna B, Andrzejewska A, Rutkowski R, Rogowski M (2007) Morphological aspect of voice disturbances of aged persons coexisting hypopharynx cancer. Folia Histochem Cytobiol 45(3):221–227

    PubMed  Google Scholar 

  19. Sato K, Hirano M (1997) Age-related changes of elastic fibers in the superficial layer of the lamina propria of vocal folds. Ann Otol Rhinol Laryngol 106(1):44–48

    Article  CAS  PubMed  Google Scholar 

  20. Sato T, Tauchi H (1982) Age changes in human vocal muscle. Mech Ageing Dev 18(1):67–74

    Article  CAS  PubMed  Google Scholar 

  21. Suzuki T, Connor NP, Lee K, Leverson G, Ford CN (2002) Laryngeal-respiratory kinematics are impaired in aged rats. Ann Otol Rhinol Laryngol 111(8):684–689

    Article  PubMed  Google Scholar 

  22. Martins RH, Pessin AB, Nassib DJ, Branco A, Rodrigues SA, Matheus SM (2015) Aging voice and the laryngeal muscle atrophy. Laryngoscope. https://doi.org/10.1002/lary.25398

    Article  PubMed  Google Scholar 

  23. Takeda N, Thomas GR, Ludlow CL (2000) Aging effects on motor units in the human thyroarytenoid muscle. Laryngoscope 110(6):018–025

    Article  Google Scholar 

  24. Paulsen FP, Tillmann BN (1999) Osteoarthritis in cricoarytenoid joint. Osteoarthr Cartil 7(6):505–514

    Article  CAS  PubMed  Google Scholar 

  25. Ishii K, Yamashita K, Akita M, Hirose H (2000) Age-related development of the arrangement of connective tissue fibers in the lamina propria of the human vocal fold. Ann Otol Rhinol Laryngol 109(11):1055–1064

    Article  CAS  PubMed  Google Scholar 

  26. Kahane JC (1988) Histologic structure and properties of the human vocal folds. Ear Nose Throat J 67(5):322 324–5, 329–30

    CAS  PubMed  Google Scholar 

  27. Serikawa M, Yamamoto M, Kawamoto A, Katori Y, Kinoshita H, Matsunaga S et al (2016) The cricothyroid joint in elderly Japanese individuals. Anat Sci Int. https://doi.org/10.1007/s12565-015-0294-x

    Article  PubMed  Google Scholar 

  28. Cardoso R, Lumini-Oliveira J, Meneses RF (2017) Associations between posture, voice, and dysphonia: a systematic review. J Voice. https://doi.org/10.1016/j.jvoice.2017.08.030

    Article  PubMed  Google Scholar 

  29. Kost KM, Sataloff RT (2018) Voice disorders in the elderly. Clin Geriatr Med. https://doi.org/10.1016/j.cger.2018.01.010

    Article  PubMed  Google Scholar 

  30. Linville SE (1996) The sound of senescence. J Voice 10(2):190–200

    Article  CAS  PubMed  Google Scholar 

  31. Mezzedimi C, Di Francesco M, Livi W, Spinosi MC, De Felice C (2017) Objective evaluation of presbyphonia: spectroacoustic study on 142 patients with Praat. J Voice. https://doi.org/10.1016/j.jvoice.2016.05.022

    Article  PubMed  Google Scholar 

  32. Pessin AB, Tavares EL, Gramuglia AC, de Carvalho LR, Martin H (2017) Voice and ageing: clinical, endoscopic and acoustic investigation. Clin Otolaryngol. https://doi.org/10.1111/coa.12725

    Article  PubMed  Google Scholar 

  33. Linville SE, Fisher HB (1985) Acoustic characteristics of women’s voices with advancing age. J Gerontol 40(3):324–330

    Article  CAS  PubMed  Google Scholar 

  34. Morris RJ, Brown WS Jr (1994) Age-related differences in speech intensity among adult females. Folia Phoniatr Logop 46(2):64–69

    Article  CAS  PubMed  Google Scholar 

  35. Goy H, Fernandes DN, Pichora-Fuller MK, van Lieshout P (2013) Normative voice data for younger and older adults. J Voice. https://doi.org/10.1016/j.jvoice.2013.03.002

    Article  PubMed  Google Scholar 

  36. Decoster W, Debruyne F (1997) Changes in spectral measures and voice-onset time with age: a cross-sectional and a longitudinal study. Folia Phoniatr Logop 49(6):269–280

    Article  CAS  PubMed  Google Scholar 

  37. Harnsberger JD, Shrivastav R, Brown WS Jr, Rothman H, Hollien H (2008) Speaking rate and fundamental frequency as speech cues to perceived age. J Voice 22(1):58–69

    Article  PubMed  Google Scholar 

  38. Yamauchi A, Imagawa H, Sakakaibara K, Yokonishi H, Ueha R, Nito T et al (2014) Vocal fold atrophy in a Japanese tertiary medical institute: status quo of the most aged country. J Voice. https://doi.org/10.1016/j.jvoice.2013.07.003

    Article  PubMed  Google Scholar 

  39. Hakkesteegt MM, Brocaar MP, Wieringa MH, Feenstra L (2006) Influence of age and gender on the dysphonia severity index. A study of normative values. Folia Phoniatr Logop 58(4):264–273

    Article  PubMed  Google Scholar 

  40. Vaca M, Cobeta I, Mora E, Reyes P (2017) Clinical assessment of glottal insufficiency in age-related dysphonia. J Voice 31(1):128.e1–128.e5

    Article  Google Scholar 

  41. Ferrand CT (2002) Harmonics-to-noise ratio: an index of vocal aging. J Voice 16(4):480–487

    Article  PubMed  Google Scholar 

  42. Maslan J, Leng X, Rees C, Blalock D, Butler SG (2011) Maximum phonation time in healthy older adults. J Voice. https://doi.org/10.1016/j.jvoice.2010.10.002

    Article  PubMed  PubMed Central  Google Scholar 

  43. Woo P, Casper J, Colton R, Brewer D (1992) Dysphonia in the aging: physiology versus disease. Laryngoscope 102(2):139–144

    Article  CAS  PubMed  Google Scholar 

  44. Biever DM, Diane MB (1989) Vibratory characteristics of the vocal folds in young adult and geriatric women. J Voice 3(2):120–131

    Article  Google Scholar 

  45. Sulter AM, Wit HP (1996) Glottal volume velocity waveform characteristics in subjects with and without vocal training, related to gender, sound intensity, fundamental frequency, and age. J Acoust Soc Am 100(5):3360–3373

    Article  CAS  PubMed  Google Scholar 

  46. Ahmad K, Yan Y, Bless D (2012) Vocal fold vibratory characteristics of healthy geriatric females—analysis of high-speed digital images. J Voice. https://doi.org/10.1016/j.jvoice.2011.12.002

    Article  PubMed  Google Scholar 

  47. Ziade G, Semaan S, Ghulmiyyah J, Kasti M, Hamdan ALH (2017) Structural and anatomic laryngeal measurements in geriatric population using MRI. J Voice. https://doi.org/10.1016/j.jvoice.2016.06.008

    Article  PubMed  Google Scholar 

  48. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4):264–269. https://doi.org/10.1016/j.jclinepi.2009.06.005

    Article  PubMed  Google Scholar 

  49. Gorman S, Weinrich B, Lee L, Stemple JC (2008) Aerodynamic changes as a result of vocal function exercises in elderly men. Laryngoscope. https://doi.org/10.1097/MLG.0b013e31817f9822

    Article  PubMed  Google Scholar 

  50. Sauder C, Roy N, Tanner K, Houtz DR, Smith ME (2010) Vocal function exercises for presbylaryngis: a multidimensional assessment of treatment outcomes. Ann Otol Rhinol Laryngol 119(7):460–467

    Article  PubMed  Google Scholar 

  51. Tay EY, Phyland DJ, Oates J (2012) The effect of vocal function exercises on the voices of aging community choral singers. J Voice. https://doi.org/10.1016/j.jvoice.2011.12.014

    Article  PubMed  Google Scholar 

  52. Ziegler A, Verdolini Abbott K, Johns M, Klein A, Hapner ER (2014) Preliminary data on two voice therapy interventions in the treatment of presbyphonia. Laryngoscope. https://doi.org/10.1002/lary.24548

    Article  PubMed  Google Scholar 

  53. Godoy J, Silverio K, Brasolotto A (2018) Effectiveness of vocal therapy for the elderly when applying conventional and intensive approaches: a randomized clinical trial. J Voice. https://doi.org/10.1016/j.jvoice.2018.03.017

    Article  PubMed  Google Scholar 

  54. Gartner-Schmidt J, Rosen C (2011) Treatment success for age-related vocal fold atrophy. Laryngoscope. https://doi.org/10.1002/lary.21122

    Article  PubMed  Google Scholar 

  55. Berg EE, Hapner E, Klein A, Johns MM III (2008) Voice therapy improves quality of life in age-related dysphonia: a case-control study. J Voice 22(1):70–74

    Article  PubMed  Google Scholar 

  56. Mau T, Jacobson BH, Garrett CG (2010) Factors associated with voice therapy outcomes in the treatment of presbyphonia. Laryngoscope. https://doi.org/10.1002/lary.20890

    Article  PubMed  PubMed Central  Google Scholar 

  57. Zhu M, Wang L, Bai X, Peng KA (2018) Hard onset therapy for functional hypoadduction and presbylaryngis: our experience in 22 patients. Clin Otolaryngol. https://doi.org/10.1111/coa.13078

    Article  PubMed  Google Scholar 

  58. Çiyiltepe M, Şenkal ÖA (2017) The ageing voice and voice therapy in geriatrics. Aging Clin Exp Res. https://doi.org/10.1007/s40520-016-0597-3

    Article  PubMed  Google Scholar 

  59. Lagorio LA, Carnaby-Mann GD, Crary MA (2010) Treatment of vocal fold bowing using neuromuscular electrical stimulation. Arch Otolaryngol Head Neck Surg. https://doi.org/10.1001/archoto.2010.33

    Article  PubMed  Google Scholar 

  60. Oates JM (2014) Treatment of dysphonia in older people: the role of the speech therapist. Curr Opin Otolaryngol Head Neck Surg. https://doi.org/10.1097/MOO.0000000000000109

    Article  PubMed  Google Scholar 

  61. Kwon TK, An SY, Ahn JC, Kim KH, Sung MW (2010) Calcium hydroxylapatite injection laryngoplasty for the treatment of presbylaryngis: long-term results. Laryngoscope. https://doi.org/10.1002/lary.20749

    Article  PubMed  Google Scholar 

  62. Sachs AM, Bielamowicz SA, Stager SV (2017) Treatment effectiveness for aging changes in the larynx. Laryngoscope. https://doi.org/10.1002/lary.26706

    Article  PubMed  Google Scholar 

  63. Allensworth JJ, O’Dell K, Ziegler A, Bryans L, Flint P, Schindler J (2018) Treatment outcomes of bilateral medialization thyroplasty for presbylaryngis. J Voice. https://doi.org/10.1016/j.jvoice.2017.10.014

    Article  PubMed  Google Scholar 

  64. Johns MM III, Arviso LC, Ramadan F (2011) Challenges and opportunities in the management of the aging voice. Otolaryngol Head Neck Surg. https://doi.org/10.1177/0194599811404640

    Article  PubMed  Google Scholar 

  65. Zealear DL, Kunibe I, Nomura K, Billante C, Singh V, Huang S et al (2009) Rehabilitation of bilaterally paralyzed canine larynx with implantable stimulator. Laryngoscope. https://doi.org/10.1002/lary.20587

    Article  PubMed  PubMed Central  Google Scholar 

  66. Tsunoda K (2009) Artificial vocal folds adjustments to a patient’s voice as easily as changing hearing aids or eyeglasses. Med Hypotheses. https://doi.org/10.1016/j.mehy.2008.09.050

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Otorhinolaryngology, San Gerardo Hospital, Via Pergolesi, 33, 20052, Monza, MB, Italy

    Francesca Galluzzi & Werner Garavello

  2. Department of Surgery and Translational Medicine, University of Milano-Bicocca, Milan, Italy

    Werner Garavello

Authors
  1. Francesca Galluzzi
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  2. Werner Garavello
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Contributions

FG and WG conceptualized and designed the study. FG designed the data collection instruments, collected and analyzed data, and critically reviewed the manuscript. WG coordinated the analysis, analyzed data and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Francesca Galluzzi.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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The authors declare that they have no conflict of interest.

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Galluzzi, F., Garavello, W. The aging voice: a systematic review of presbyphonia. Eur Geriatr Med 9, 559–570 (2018). https://doi.org/10.1007/s41999-018-0095-6

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  • DOI: https://doi.org/10.1007/s41999-018-0095-6

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