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Original Investigation
July 2018

Assessment of Clinical and Social Characteristics That Distinguish Presbylaryngis From Pathologic Presbyphonia in Elderly Individuals

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Voice and Swallowing Center, Loma Linda University Health, Loma Linda, California
  • 2School of Nursing, Loma Linda University Health, Loma Linda, California
  • 3School of Medicine, Loma Linda University Health, Loma Linda, California
  • 4University of Aleppo School of Medicine, Aleppo, Syria
JAMA Otolaryngol Head Neck Surg. 2018;144(7):566-571. doi:10.1001/jamaoto.2018.0409
Key Points

Question  What factors distinguish pathologic presbyphonia from presbylaryngis?

Findings  In this cohort study of 57 people older than 74 years, Voice Handicap Index-10 and Voice-Related Quality of Life scores and scores for jitter and shimmer were significantly higher in those with pathologic presbyphonia. Other findings did not differ, although female sex and decreased respiratory capacity were more likely to be associated with pathologic presbyphonia.

Meaning  Pathologic presbyphonia is not explained solely by the presence of presbylaryngis; factors that influence pathologic presbyphonia include respiratory capacity and sex, as well as presbylaryngis.


Importance  An aging population experiences an increase in age-related problems, such as presbyphonia. The causes of pathologic presbyphonia are incompletely understood.

Objective  To determine what distinguishes pathologic presbyphonia from presbylaryngis.

Design, Setting, and Participants  This was a cohort study at an outpatient otolaryngology subspecialty clinic of a tertiary academic referral center. Participants were consecutive consenting adults older than 74 years without laryngeal pathologic abnormalities who visited the clinic as participants or companions. Patient questionnaires, otolaryngologic, video stroboscopic, and voice examinations were compiled. Patients were divided into groups based on whether they endorsed a voice complaint. Three blinded authors graded stroboscopic examinations for findings consistent with presbylaryngis (vocal fold bowing, vocal process prominence, glottic insufficiency).

Main Outcomes and Measures  Voice Handicap Index–10, Reflux Symptom Index, Cough Severity Index, Dyspnea Index, Singing Voice Handicap Index-10 , Eating Assessment Tool -10, Voice-Related Quality of Life (VRQOL), and Short-Form Health Survey; face-sheet addressing social situation, work, marital status, education, voice use, transportation; acoustic and aerodynamic measures; and a full otolaryngologic examination, including videostroboscopic imaging.

Results  A total of 31 participants with dysphonia (21 were female; their mean age was 83 years [range, 75-97 years]) and 26 control participants (16 were female; their mean age was 81 years [range, 75-103 years]) completed the study. Presbylaryngis was visible in 27 patients with dysphonia (87%) and 22 controls (85%). VHI-10 and VRQOL scores were worse in patients with pathologic presbyphonia (median [range] VHI-10 scores, 15 (0-40) vs 0 (0-16) and median VRQOL score, 19 [0-43] vs 10 [10-23]). All other survey results were indistinguishable, and no social differences were elucidated. Acoustic measures revealed that both groups averaged lower than normal speaking fundamental frequency (mean [SD], 150.01 [36.23] vs 150.85 [38.00]). Jitter was 3.44% (95% CI, 2.46%-4.61%) for pathologic presbyphonia and 1.74% (95% CI, 1.35%-2.14%) for controls (d = 0.75). Shimmer means (95% CI) were 7.8 2 (6.08-10.06) for the pathologic presbyphonia group and 4.84 (3.94-5.72) for controls (d = 0.69). Aerodynamic measures revealed an odds ratio of 3.03 (95% CI, 0.83-11.04) for patients with a maximum phonation time of less than 12 seconds who had complaints about dysphonia.

Conclusions and Relevance  Presbylaryngis is present in most ambulatory people older than 74 years. Some will endorse pathologic presbyphonia that has a negative effect on their voice and quality of life. Pathologic presbyphonia seems to be influenced by respiratory capacity and sex. Further study is required to isolate other social, physiologic, and general health characteristics that contribute to pathologic presbyphonia.