Objective: The primary objective of this study was to assess objective voice measures in an elderly population representative of those seen in a tertiary laryngology practice, stratified by sex and presbylarynx status, and compare their measures to each other and to a cohort of young adult patients aged 40 years or less. The secondary objectives of this study were to evaluate and compare the strobovideolaryngoscopy findings across all groups and compare the voice complaints and subjective questionnaire results between the presbylarynx and non-presbylarynx groups.
Methods: Two hundred and eighty-six adult voice patients (147 females/139 males) were included in this study and stratified into one of three groups: (1) young adults aged 40 years or less (n = 122), (2) patients over the age of 60 without presbylarynx (n = 78), and (3) patients over the age of 60 with a diagnosis of presbylarynx (n = 86). The acoustic analysis included fundamental frequency (F0), voice intensity, standard deviation of the fundamental frequency (SDFF), jitter (Jitt), relative average perturbation (RAP), shimmer (Shim), noise-to-harmonic ratio (NHR), and others. The aerodynamic and pulmonary assessment included maximum phonation time (MPT), S/Z ratio, mean flow rate (MFR), forced expiratory volume in 1 second (FEV1), and maximal mid-expiratory flow (FEF25-75). Coexisting vocal fold conditions and pathologies were also characterized and compared. Statistical analysis was performed using SPSS 28.0.0.0 (IBM, Armonk, NY). All tests were performed in two-tailed, and a P value of less than 0.05 was considered statistically significant.
Results: Assessment of vocal fold features revealed a significantly higher prevalence of benign vocal fold lesions in the young adult group for males and females compared to both elderly groups but significantly lower prevalence of vocal fold edema only in young adult females compared to the elderly female groups. Among males, young adults differed significantly from both elderly groups with regard to SDFF, Shim, FEV1, and FEF25-75. However, Jitt and RAP only differed significantly between the young adult and presbylarynx groups. Among females, young adults differed significantly from both elderly groups for F0, SDFF, Jitt, RAP, NHR, CPP, MFR, FEV1, and FEF25-75. However, the non-presbylarynx group had a significantly lower S/Z ratio than the young adult and presbylarynx groups. A comparison of voice complaints between elderly groups revealed breathiness to be significantly more common in the presbylarynx group compared to the non-presbylarynx group, but no other significant differences were found in voice complaints or questionnaire scores.
Conclusion: When interpreting objective voice measures, it is critical to consider differences in vocal fold features alongside age-related changes. In addition, sex-related differences in anatomy and the aging process may explain discrepancies in significant findings between young adults and elderly patients stratified by presbylarynx status. However, presbylarynx status alone appears insufficient to generate significant differences in most objective voice measures among the elderly. Yet, presbylarynx status may be sufficient to generate differences in perceptual voice symptoms.
Keywords: Acoustic analysis; Aerodynamic analysis; Cepstral parameters; Elderly voice; Presbylarynx.
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