Patient Etiologies and Treatment Outcomes for Dysphonia Differ Between Key Age Groups

by Linda Kossoff •

How do presenting symptoms, etiology, and treatment outcomes compare among dysphonic adults younger and older than 65 years of age?

BOTTOM LINE

There are notable pathophysiological differences between adult patient groups older and younger than 65 years of age; patients older than 65 can obtain significant benefits from surgery and voice therapy.

BACKGROUND: Referrals for patients with dysphonia who are older than 65 years are accelerating. Voice disorders in these patients can contribute to social isolation, depression, and decreased quality of life. Therefore, it’s important for healthcare providers to understand the nature of their voice problems and their capacity for rehabilitation.

COMMENT: This article provides a valuable overview on differing pathophysiology for patients with dysphonia depending on age group at presentation. In addition, it discusses treatment options and outcomes that can assist with patient counseling. —Cristina Cabrera-Muffly, MD

STUDY DESIGN: Retrospective cohort study.

SETTING: Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kan.

SYNOPSIS: Researchers identified 755 adult patients (481 females) with a primary complaint of dysphonia who were evaluated at a tertiary care voice center between January 2011 and June 2016. Of these, 513 patients were younger than 65 years (<65 group) and 242 were older than 65 years (>65 group). The most reported presumptive diagnosis was laryngopharyngeal reflux (LPR). Information on referrals, diagnoses, treatments, coexisting symptoms, and pre- and post-intervention Voice Handicap Index (VHI) scores was collected. A primary analysis compared the two age cohorts; additional analysis was based on treatment: surgical management (139), medical therapy (251), or voice therapy (VT) (156). Both groups demonstrated improvement in VHI scores after surgery and VT, but the improvement after VT was greater in the >65 group. Improvements from surgery were greater in the <65 group. The most common etiologies in the <65 and >65 groups were vocal cord lesions and vocal cord atrophy, respectively. Study limitations included lack of objective testing for an LPR diagnosis.

CITATION: Jacks A, Kavookgian H, Kraft S. Comparative evaluation and management of dysphonia between adults <65 and >65 years of age. Otolaryngol Head Neck Surg. 2021;165:142-148.