Voice Disorders in the Elderly

Objectives. Despite the prevalence of voice disorders, as well as the physiological and functional changes of the aging larynx, there is a lack of data analyzing dysphonia in the geriatric population. The goal of this study was to investigate dysphonia in this cohort. Study Design. Retrospective chart review. Methods. This study analyzes the histories, demographics, Voice Handicap Index (VHI) questionnaires, and objective voice measures (OVMs) for 175 patients with voice complaints, age ranging from 65 to 89 years. Diagnoses of any vocal fold pathology were made via strobovideolaryngoscopy and laryngeal electromyography (LEMG) at the time of presentation. Results. Strobovideolaryngoscopy revealed that laryngeal laryngopharyngeal reflux in 91% (N = 159) was the most common diagnosis associated with the voice complaints, followed by muscle tension dysphonia in 73% (N = 127) and paresis in 72% (N = 126). Of the 175 patients in this study, 27% (N = 48) of patients had a history of antecedent event, which might have contributed to their current dysphonia, most commonly upper respiratory tract infection in 27% (N = 13) and endotracheal intubation in 21% (N = 10). Ninety-three percent (N = 153) of patients who underwent LEMG had weakness in the distribution of at least one nerve. VHI scores varied greatly, ranging from 4 to 104, with an average score of 43.9. When VHI scores were correlated with OVMs, correlations were found with mean jitter (%), jitter (abs.), maximum phonation time (s), and shimmer (%). When OVM scores were compared with KayPENTAX normative thresholds, 69.7% of subjects were found to be above the threshold for soft phonation index. Conclusion. Our studies identified at least one pathologic factor contributing to dysphonia in all elderly patients presenting with voice complaints. The high average VHI score indicated that these geriatric patients experienced significant dissatisfaction because of their dysphonia. The problem was of sufficient magnitude to result in a high percentage of patients proceeding with treatment. Additional research is needed to determine normative values for OVMs and other assessments in the elderly population and establish whether normative values in common use are appropriate for this population.