To what extent is the glottic gap area a significant marker for the severity of presbyphonia as it relates to patient-reported outcome measures and stroboscopic findings?
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July 2021Data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary muscle tension dysphonia (MTD) alone.
BACKGROUND: Presbyphonia is a diagnosis of exclusion made in patients greater than age 60 with dysphonia, subjective vocal fold atrophy, and absence of other laryngeal pathology. Regarding appropriate treatment, there exists no means to stratify patients with presbyphonia for vocal fold augmentation versus voice therapy on presentation.
STUDY DESIGN: Retrospective case-control study.
SETTING: Department of Otolaryngology–Head and Neck Surgery, University of Virginia Health System, Charlottesville, Va.
SYNOPSIS: Researchers selected 33 patients (11 women, 22 men, mean age 79.9) diagnosed with vocal atrophy without other organic laryngeal pathology for data analysis from January 2014 to December 2017. Thirty-three controls (15 women, 18 men, mean age 73.3 years) were also selected (see Table 1). Laryngeal stroboscopy videos were taken, and still images for measuring glottic gap were captured at the onset of phonation. Software was used to measure the glottic gap area and its width in reference to overall vocal fold length (see Table 2). Compared to controls, presbyphonia patients had larger glottic gap areas and greater open-phase quotients on laryngeal videostroboscopy. Findings indicated that a larger glottic gap area did not correlate with patient-reported vocal function or presence of MTD in this group. In addition, data results suggest that trained raters of vocal fold glottic gap area can measure the area with strong inter-rater reliability, providing a quantifiable way to measure glottal gap. Study limitations included the six-year mean age difference between presbyphonia and control groups and challenges in obtaining high-quality videostroboscopic still images during a mobile procedure.
Table 1: Patient and Control Characteristics.
| Atrophy Cohort (n = 33) | Control Cohort (=33) | P Value | |
|---|---|---|---|
| Mean age (yr) | 79.9 + 8.0 | 73.3 + 9.7 | 0.004 |
| Age range (yr) | 65–96 | 59–93 | |
| Male (%) | 22 (66.7%) | 18 (54.5%) | 0.435 |
| Female (%) | 11 (33.3%) | 15 (45.5%) | |
| Mean VHI-10 | 16.2 + 10.5 | 3.6 + 5.4 | <.001 |
| Range VHI-10 | 0–33 | 0–22 | |
| Presence of secondary MTD (%) | 20 (60.1%) | 0 | <.001 |
MTD = muscle tension dysphonia; VHI = Voice Handicap Index-10.
Table 2: Glottic Gap and Videostroboscopy Measurements.
| Atrophy Cohort (n = 33) | Control Cohort (=33) | P Value | |
|---|---|---|---|
| HALOGEN MEASUREMENTS: | |||
| Mean normalized glottic gap area | 408.3 37.4 | 196.9 57.1 | <.001 |
| Mean normalized glottal gap width | 7.8 .0 | 4.3 .1 | <.001 |
| STROBOSCOPY ANALYSIS: | |||
| Modal phonation open quotient (%) | 0.806 | 0.604 | <.001 |
| Incomplete glottic closure (%) | 0.333 | 0 | 0.011 |
| Falsetto phonation open quotient (%) | 0.944 | Data not available | |
| Incomplete glottic closure (%) | 0.636 | Data not available | <.001 |
CITATION: McGarey PO Jr, Bitar R, Hughes CK, et al. Correlation of glottic gap and voice impairment in presbyphonia. Laryngoscope. 2021;131:1594-1598.