The quality of an individual’s voice often declines with age. This deterioration occurs firstly as a result of vocal fold atrophy secondary to histologic alteration of the vocal fold mucosa as well as atrophy of the laryngeal musculature. Phonatory efficiency is additionally reduced through a decrease in lung elasticity, vital capacity and respiratory strength. Surgical interventions that have been utilised for presbyphonia include medialisation thyroplasty and injection laryngoplasty. Functional improvements are however reported to be modest with these procedures. In this paper, 16 patients with presbyphonia (age range 65 to 81 years) were treated with voice therapy comprising vocal function exercises. Multiple outcomes were assessed for this intervention group including pre- and post-treatment voice quality on the GRBAS scale, acoustic analysis and voice handicap index-10 (VHI-10) scores. Stroboscopic examination was also employed to assess the normalised mucosal wave amplitude (NMWA), normalised glottal gap (NGG) and bowing index. The same outcomes were assessed for a historical control group of six patients with the same diagnosis who did not receive any intervention. Following voice therapy, significant improvements were noted in GRBAS and VHI-10 scores in the intervention group as well as stroboscopic examination findings (with the exception of the bowing index). No significant improvements were noted in historical control outcomes. The results of this small, retrospective study would suggest that vocal function exercises are an effective form of treatment for presbyphonia, and are likely to achieve their effect through improvement in laryngeal muscular functioning. As such, the paper would tend to support a management strategy of voice therapy as a first-line treatment for presbyphonia, with surgery reserved only for cases resistant to such treatment.

Multidimensional analysis on the effect of vocal function exercises on aged vocal fold atrophy.
Kaneko M, Hirano S, Tateya I, Kishimoto Y, Hiwatashi N, Fujiu-Kurachi M, Ito J.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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