return to: Injection Laryngoplasty for Vocal Fold Paralysis and Glottic Incompetence
Presbyphonia defines age related voice changes. Presbylaryngis more specifically refers to the anatomic changes accompanying presbyphonia - including loss of substance associated with muscle atrophy (Kwon 2010). First line therapy for presbyphonia with presbylaryngis is voice therapy, generally directing the patient to a speech pathologist with expertise in addressing vocal problems (Johns M 2011). Cases refractory to voice therapy may benefit from vocal fold augmentation or medialization via injection or thyroplasty.
Gartner-Schmidt and Rosen (2011) recently identified that "neither voice therapy nor surgery should be considered a certainty in helping patients with age-related vocal fold atrophy". Their efforts to quantify improvement with therapy identified that 81% diagnosed with vocal fold atrophy improved with voice therapy, but only by 48%". These investigators identified that "only 17% of the participants got better with surgery after voice therapy failed". They concluded that other comorbidities associated with advanced age may contribute the the voicing problems in a way that are not fully remediated with vocal fold augmentation or medialization.
Case Example
Gradual decline in vocal quality ascribed to presbylaryngis. Recommendation re: voice therapy as primary management met with unproductive encounters warranting consideration for vocal fold augmentation.
2-21-2011: Transnasal fiberoptic injection laryngoplasty to left vocal cord with zyderm II yielded immediate vocal improvement but deterioration after 1 - 3 weeks. A second injection laryngoplasty 8-05-2011 done via approach below (see video) yielded immediate improvement in ease and strength of speaking persisting for one month (via phone call f/u). Subsequent f/u by phone (11-13-11) indicated that the benefit did not appear to persist beyond one month. Options discussed included thyroplasty, further consideration for voice therapy.
Click on video below to activate - audio begins after 4 seconds:
References
Kwon T-K, An S-Y, Ahn J-C, Kim K, Sung M-W: Calcium hydroxylapatite injection laryngoplasty fo rthe treatment of presbylaryngis: Long-term results. Laryngoscope volume 120, Issue 2 pp 326-329, Feb 2010.
Johns M, Arviso LC, Ramadan F: Challenges and opportunities in the management of the aging voice. Otolaryngol Head Neck Surg 2011;145)1):1-6
Gartner-Schmidt J and Rosen C: Treatment success for age-related vocal fold atrophy. Laryngosocpe 2011 Mar;121 (3):585-9