Are factors such as age, gender, degree of vocal fold atrophy and the burden of medical problems associated with voice therapy outcomes for presbyphonia?
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June 2010Background: Although voice therapy is generally considered the mainstay of rehabilitation for the aging voice, there is little data on its efficacy for this indication, especially with regard to the effects of age, degree of glottic closure, degree of vocal fold atrophy and the burden of medical problems. Previous studies of dysphonia in aged persons have shown physiologic aging to account for only a minority of voice problems, and therefore might lead to under-treatment of this group of patients.
Study Design: Retrospective review
Setting: Vanderbilt Voice Center, Vanderbilt University Medical Center, Nashville, Tenn.
Synopsis: Researchers screened the records of patients seen over a three-year period. For the study they chose 67 patients over age 55 with a primary complaint of hoarseness, presence of vocal fold atrophy on examination and absence of laryngeal or neurological pathology. They team assessed voice therapy outcomes with the American Speech-Language-Hearing Association National Outcomes Measurement System scale and performed statistical analysis. Of these patients, 85 percent demonstrated improvement with voice therapy, and the most common type of glottic closure was a slit gap. Gender or age had no effect on voice therapy outcomes. Larger glottic gaps on initial stroboscopy examination and more pronounced vocal fold atrophy were weakly correlated with less improvement and a weak correction was also found between the number of chronic medical conditions and poorer outcomes. The authors said the fact that many patients did not have large glottal gaps may be a source of bias in the overall favorable outcome from voice therapy.
Bottom Line: Advanced age does not portend poorer outcomes with voice therapy. Patients with larger glottal gaps and more severe atrophy may improve less with voice therapy than those with better glottic competence on initial examination. The degree of improvement may also be influenced by medical problems.
Citation: Mau T, Jacobson BH, Garrett CG. Factors associated with voice therapy outcomes in the treatment of presbyphonia. The Laryngoscope. 2010;120(6):1181-1187.
—Reviewed by Sue Pondrom