Research Article| Volume 34, ISSUE 3, P415-425, May 2020

Biobehavioral Measures of Presbylaryngeus

Published:November 29, 2018DOI:



      The objective of this observational study was to assess the relationship between established aging biobehavioral measures and voice decline in normally aging adults.

      Study design

      Cross-sectional study.


      Participants 60–85 years of age were divided into two age and sex-matched groups, based on the presence or absence of presbylaryngeus. Both groups underwent a battery of tests measuring anthropometric variables, inflammatory markers, general health measures, and vocal function parameters. Differences from the norm were calculated for all variables. Parametric and nonparametric tests were performed to assess group differences. In addition, variable selection analysis was performed to determine variables that were most influential in predicting the occurrence of presbylaryngeus in our current sample.


      Fifty-three participants were divided into age and sex-matched groups of “presbylaryngeus” (n = 26) and “non-presbylaryngeus” (n = 27). The two groups were statistically different in select measures of inflammatory markers, general health measures, and vocal function parameters. Anthropometric measures were not statistically different. Based on variable selection, the variables most predictive of the presence of presbylaryngeus were measures of the Physical Activity Scale of the Elderly, C-reactive protein, laryngeal airway resistance, and vocal roughness.


      In addition to group differences in vocal function measures, results for the presbylaryngeus group consistently trended sub-optimally on anthropometric measures, two inflammatory markers, and general health measures. These results suggest that this sample of individuals with presbylaryngeus demonstrated greater biobehavioral deficits associated with aging as compared to age and sex-matched non-presbylaryngeus individuals.

      Level of Evidence

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Roy N
        • Stemple J
        • Merrill RM
        • et al.
        Epidemiology of voice disorders in the elderly: preliminary findings.
        Laryngoscope. 2007; 117: 628-633
      1. Census U. United States Census. 2010.

        • Sprott RL.
        Biomarkers of aging and disease: introduction and definitions.
        Exp Gerontol. 2010; 45: 2-4
        • Butler RN
        • Sprott R
        • Warner H
        • et al.
        Aging: the reality: biomarkers of aging: from primitive organisms to humans.
        J Gerontol Ser A: Biol Sci Med Sci. 2004; 59: B560-B567
      2. Waist Circumference and Waist-Hip Ratio: Report of a WHO Expert Consultation.
        WHO, 2011
      3. Healthy weight.
        • Jylhä M
        • Paavilainen P
        • Lehtimäki T
        • et al.
        Interleukin-1 receptor antagonist, interleukin-6, and C-reactive protein as predictors of mortality in nonagenarians: the vitality 90+ study.
        J Gerontol Ser A: Biol Sci Med Sci. 2007; 62: 1016-1021
        • Washburn RA
        • Smith KW
        • Jette AM
        • et al.
        The physical activity scale for the elderly (PASE): development and evaluation.
        J Clin Epidemiol. 1993; 46: 153-162
        • Cohen S
        • Kamarck T
        • Mermelstein R
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 386-396
        • Tinetti ME
        • Williams TF
        • Mayewski R
        Fall risk index for elderly patients based on number of chronic disabilities.
        Am J Med. 1986; 80: 429-434
        • Singh T
        • Newman AB
        Inflammatory markers in population studies of aging.
        Ageing Res Rev. 2011; 10: 319-329
        • Woo J
        • Leung J
        • Kwok T
        BMI, body composition, and physical functioning in older adults.
        Obesity (Silver Spring). 2007; 15: 1886-1894
        • Schaap LA
        • Pluijm SM
        • Deeg DJ
        • et al.
        Inflammatory markers and loss of muscle mass (sarcopenia) and strength.
        Am J Med. 2006; 119 (526. e529–526. e517)
        • Roubenoff R
        Sarcopenia: effects on body composition and function.
        J Gerontol Ser A: Biol Sci Med Sci. 2003; 58: M1012-M1017
        • Visser M
        • Deeg DJ
        • Lips P
        Low vitamin D and high parathyroid hormone levels as determinants of loss of muscle strength and muscle mass (sarcopenia): the Longitudinal Aging Study Amsterdam.
        J Clin Endocrinol Metab. 2003; 88: 5766-5772
        • Ryall JG
        • Schertzer JD
        • Lynch GS
        Cellular and molecular mechanisms underlying age-related skeletal muscle wasting and weakness.
        Biogerontology. 2008; 9: 213-228
        • Brinkley TE
        • Leng X
        • Miller ME
        • et al.
        Chronic inflammation is associated with low physical function in older adults across multiple comorbidities.
        J Gerontol Ser A: Biomed Sci Med Sci. 2009; 64: 455-461
        • Schaap LA
        • Pluijm SM
        • Deeg DJ
        • et al.
        Higher inflammatory marker levels in older persons: associations with 5-year change in muscle mass and muscle strength.
        J Gerontol Ser A: Biomed Sci Med Sci. 2009; 64: 1183-1189
        • Lim S
        • Kwon SY
        • Yoon JW
        • et al.
        Association between body composition and pulmonary function in elderly people: the Korean Longitudinal Study on Health and Aging.
        Obesity. 2011; 19: 631-638
        • Colbert LH
        • Visser M
        • Simonsick EM
        • et al.
        Physical activity, exercise, and inflammatory markers in older adults: findings from the Health, Aging and Body Composition Study.
        J Am Geriatr Soc. 2004; 52: 1098-1104
        • Thompson HJ
        • Voss JG
        Health-and disease-related biomarkers in aging research.
        Res Gerontol Nurs. 2009; 2: 137-148
        • Epel ES
        • Blackburn EH
        • Lin J
        • et al.
        Accelerated telomere shortening in response to life stress.
        Proc Natl Acad Sci. 2004; 101: 17312-17315
        • Bach AC
        • Lederer FL
        • Dinolt R
        Senile changes in the laryngeal musculature.
        Arch Otolaryngol. 1941; 34: 47-56
        • Hoit JD
        • Hixon TJ
        • Altman ME
        • et al.
        Speech breathing in women.
        J Speech Hearing Res. 1989; 32: 353-365
        • Melcon MC
        • Hoit JD
        • Hixon TJ
        Age and laryngeal airway resistance during vowel production.
        J Speech Hearing Disord. 1989; 54: 282-286
        • Hirano M.
        Clinical Examination of Voice.
        Springer Verlag, New York1981
        • Hirano M
        • Kakita Y
        Cover-body theory of vocal fold vibration.
        in: Daniloff RG Speech Science: Recent Advances. College-Hill Press, San Diego1985: 1-46
        • Hirano M
        • Kurita S
        • Sakaguchi S
        Ageing of the vibratory tissue of human vocal folds.
        Acta Otolaryngol. 1989; 107: 428-433
        • Honjo I
        • Isshiki N
        Laryngoscopic and voice characteristics of aged persons.
        Arch Otolaryngol. 1980; 106: 149-150
        • Kahane JC
        Histologic structure and properties of the human vocal folds.
        Ear Nose Throat J. 1988; 67 (322, 324–325, 329–330)
        • Leslie P
        • Drinnan MJ
        • Ford GA
        • et al.
        Swallow respiratory patterns and aging: presbyphagia or dysphagia?.
        J Gerontol A Biol Sci Med Sci. 2005; 60: 391-395
        • Mueller PB
        • Sweeney RJ
        • Baribeau LJ
        Acoustic and morphologic study of the senescent voice.
        Ear Nose Throat J. 1984; 63: 292-295
        • Mueller PB
        • Sweeney RJ
        • Baribeau LJ
        Senescence of the voice: morphology of excised male larynges.
        Folia Phoniatr (Basel). 1985; 37: 134-138
        • Mysak ED
        • Hanley TD
        Vocal aging.
        Geriatrics. 1959; 14: 652-656
        • Sato K
        • Hirano M
        • Nakashima T
        Age-related changes of collagenous fibers in the human vocal fold mucosa.
        Ann Otol Rhinol Laryngol. 2002; 111: 15-20
        • Segre R
        Senescence of the voice.
        Eye Ear Nose Throat Mon. 1971; 50: 223-227
        • Berg EE
        • Hapner E
        • Klein A
        • et al.
        Voice therapy improves quality of life in age-related dysphonia: a case-control study.
        J Voice. 2008; 22: 70-74
        • Israel H
        Age factor and the pattern of change in craniofacial structures.
        Am J Phys Anthropol. 1973; 39: 111-128
        • Kahane JC
        Anatomic and physiologic changes in the aging peripheral speech mechanism.
        in: Beasley DS Davis GA Aging: Communication Processes and Disorders. Grune and Stratton, New York1981: 21-45
        • Lasker GW
        The age factor in bodily measurements of adult male and female Mexicans.
        Hum Biol. 1953; 25: 50-63
        • Coyle SM
        • Weinrich BD
        • Stemple JC
        Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population.
        J Voice. 2001; 15: 424-440
        • Herrington-Hall BL
        • Lee L
        • Stemple JC
        • et al.
        Description of laryngeal pathologies by age, sex, and occupation in a treatment-seeking sample.
        J Speech Hear Disord. 1988; 53: 57-64
        • Miller MK
        • Verdolini K
        Frequency and risk factors for voice problems in teachers of singing and control subjects.
        J Voice. 1995; 9: 348-362
        • Roy N
        • Merrill RM
        • Thibeault S
        • et al.
        Voice disorders in teachers and the general population: effects on work performance, attendance, and future career choices.
        J Speech Lang Hear Res. 2004; 47: 542-551
        • Roy N
        • Merrill RM
        • Thibeault S
        • et al.
        Prevalence of voice disorders in teachers and the general population.
        J Speech Lang Hear Res. 2004; 47: 281-293
        • Schneider B
        • Bigenzahn W
        Vocal risk factors for occupational voice disorders in female teaching students.
        Eur Arch Otorhinolaryngol. 2005; 262: 272-276
        • Smith E
        • Gray SD
        • Dove H
        • et al.
        Frequency and effects of teachers' voice problems.
        J Voice. 1997; 11: 81-87
        • Smith E
        • Kirchner HL
        • Taylor M
        • et al.
        Voice problems among teachers: differences by gender and teaching characteristics.
        J Voice. 1998; 12: 328-334
        • Smith E
        • Lemke J
        • Taylor M
        • et al.
        Frequency of voice problems among teachers and other occupations.
        J Voice. 1998; 12: 480-488
        • Thibeault SL
        • Merrill RM
        • Roy N
        • et al.
        Occupational risk factors associated with voice disorders among teachers.
        Ann Epidemiol. 2004; 14: 786-792
        • Verdolini K
        • Ramig LO
        Review: occupational risks for voice problems.
        Logoped Phoniatr Vocol. 2001; 26: 37-46
        • Williams NR.
        Occupational groups at risk of voice disorders: a review of the literature.
        Occup Med (Lond). 2003; 53: 456-460
        • Borson S
        • Scanlan J
        • Brush M
        • et al.
        The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly.
        Int J Geriatr Psychiatry. 2000; 15: 1021-1027
        • Hubbard RE
        • Lang IA
        • Llewellyn DJ
        • et al.
        Frailty, body mass index, and abdominal obesity in older people.
        J Gerontol Ser A: Biol Sci Med Sci. 2010; 65: 377-381
        • Enright PL
        • Kronmal RA
        • Manolio TA
        • et al.
        Respiratory muscle strength in the elderly. Correlates and reference values. Cardiovascular Health Study Research Group.
        Am J Respir Crit Care Med. 1994; 149: 430-438
        • Wassel CL
        • Barrett-Connor E
        • Laughlin GA
        Association of circulating C-reactive protein and interleukin-6 with longevity into the 80s and 90s: The Rancho Bernardo Study.
        J Clin Endocrinol Metab. 2010; 95: 4748-4755
        • Gorman S
        • Weinrich B
        • Lee L
        • et al.
        Aerodynamic changes as a result of vocal function exercises in elderly men.
        Laryngoscope. 2008; 118: 1900-1903
        • WHO
        STEPwise approach to surveillance (STEPS).
        • CDC
        BMI for adults.
        • WHO
        Waist circumference measurement guidelines.
        • Baumgartner RN
        Body composition in healthy aging.
        Ann N Y Acad Sci. 2000; 904: 437-448
        • Kim HO
        • Kim H-S
        • Youn J-C
        • et al.
        Serum cytokine profiles in healthy young and elderly population assessed using multiplexed bead-based immunoassays.
        J Transl Med. 2011; 9: 113
      4. C- reactive protein test.
      5. Roberts HC, Denison HJ, Martin HJ, et al. A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 2011:afr051

      6. Jamar. Hydraulic Hand Dynamometer Owner's Manual. In: Patternson Medical:12.

        • Neder JA
        • Andreoni S
        • Lerario M
        • et al.
        Reference values for lung function tests: II. Maximal respiratory pressures and voluntary ventilation.
        Braz J Med Biol Res. 1999; 32: 719-727
        • Hirano M
        • Bless DM
        Videostroboscopic Examination of the Larynx.
        Singular, 1993
        • Zraick RI
        • Kempster GB
        • Connor NP
        • et al.
        Establishing validity of the consensus auditory-perceptual evaluation of voice (CAPE-V).
        Am J Speech Lang Pathol. 2011; 20: 14-22
        • Kempster GB
        • Gerratt BR
        • Verdolini Abbott K
        • et al.
        Consensus auditory-perceptual evaluation of voice: development of a standardized clinical protocol.
        Am J Speech Lang Pathol. 2009; 18: 124-132
        • Baken R
        • Orlikoff R
        Clinical Measurement of Voice and Speech.
        Singular, San Diego2000
        • Awan S.
        Analysis of Dysphonia in Speech and Voice (ADSV): an Application Guide.
        KayPentax, Montvale, NJ2011
        • Jacobson BH
        • Johnson A
        • Grywalski C
        • et al.
        The voice handicap index (VHI): development and validation.
        Am J Speech-Lang Pathol. 1997; 6: 66-70
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Validity and reliability of the reflux symptom index (RSI).
        Journal Voice. 2002; 16: 274-277