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Presbylaryngis Transnasal Laryngoscopy (vocal cord thinning with age)

last modified on: Tue, 01/09/2024 - 15:01

return to: Videostroboscopy; Transnasal Laryngoscopy Normal Exam with High Definition and Narrow Band Imaging (NBI)

Video below of the transnasal flexible laryngoscopy of 82 yo male whose wife (who has a hearing loss) complained 'he mumbles' despite his absence of concerns about his speaking

Transnasal laryngoscopy showing vocal fold thinning with age

Presbyphonia (impaired voice production with aging) when coupled with presbyacusis (impaired hearing with aging) create communication problems that are becoming more common with aging of the population.

Symptoms of presbyphonia are vary individually as to age of presentation and are dependent on general health conditions. Goncalves et al (2019) described presbyphonia as a voice that is lower, (in amplitude) shaky and breathy making speaking and singing difficult. 

Presbylaryngis - the structural changes that occur in the aged larynx - do not necessarily result in presbyphonia (Crawley 2018). Age-related changes to the lung function powering the voice is a key factor in producing presbyphonia. Decrease in the maximum inspiratory pressure (see MIP and also Spirometry PIF Peak Inspiratory Flow) is considered a natural process of aging (Black 1969). Age-related degeneration of the larynx has included reports of change in muscle type and decrease in blood flow, with loss of muscle volume (Mallick 2019, Goncalves 2019).  

A differential diagnosis offered by Mallick et al (2019) for presbyphonia associated with presbylaryngis includes:

  • Parkinson's disesae
  • Unilateral/bilateral presis
  • Sulcus vergeture
  • Scarring

Mallick et al (2019) identify voice therapy as the cornerstone of treatment for presbyphonia with the understanding that not all patients will feel sufficiently impaired as to desire this intervention. They relate that surgical intervention (injection laryngoplasty or thyroplasty) should be reserved for those patients who fail to respond to voice therapy - with questions remaining about the optimal choice for type of surgical intervention. 

References

Mallick AS, Garas G, McGlashan J: Presbylaryngis: a state-of-the-art review. Curr Opin Otolaryngol Head Neck Surg 2019 Mar 27

Roy N, Stemple J, Merrill RM, Thomas L. Epidemiology of voice disorders in the elderly: preliminary findings. Laryngoscope 2007; 117:628–633.

Crawley BK, Dehom S, Thiel C, et al. Assessment of clinical and social characteristics that distinguish presbylaryngis from pathologic presbyphonia in elderly individuals. JAMA Otolaryngol Head Neck Surg 2018; 144:566–571.

Black LF, Hyatt RE. Maximal respiratory pressures: normal values and relationship to age and sex. Am Rev Respir Dis 1969; 99:696–702

Sato T, Tauchi H. Age changes in human vocal muscle. Mech Ageing Dev 1982; 18:67–74

Goncalves TM, Dos Santos DC, Pessin AB, Martins RH. Scanning electron microscopy of the presbylarynx. Otolaryngol Head Neck Surg 2016; 154:1073–1078.

Bloch I, Behrman A.Quantitative analysis of videostroboscopic images in presbylarynges. Laryngoscope. 2001 Nov;111(11 Pt 1):2022-7.

Stager SV1, Bielamowicz SA.J Speech Lang Hear Res. 2010 Feb;53(1):100-13. doi: 10.1044/1092-4388(2009/08-0244). Epub 2009 Nov 30.Using laryngeal electromyography to differentiate presbylarynges from paresis.