Summary
Purpose
To determine cut-off points in auto-assessment questionnaires to predict the presence
and extent of presbylarynx signs.
Method
This case control, prospective, observational, and cross-sectional study was carried
out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center,
in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and
presbylarynx was considered when it was identified two or more of the following endoscopic
findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped
glottal gap. Each subject completed three questionnaires: the Voice Handicap Index
(VHI), with 30 and 10 questions, and the “Screening for voice disorders in older adults
questionnaire” (RAVI).
Results
The studied population included 174 Caucasian subjects (60 males; 114 females), with
a mean age of 73.99 years (standard deviation = 6.37; range 65–95 years). Presbylarynx
was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap
was identified in 22 patients (31%). The mean score of VHI-30 between “no presbylarynx”
and “presbylarynx” groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence
of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between “no presbylarynx” and “presbylarynx” groups
was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients
with presbylarynx, the presence of glottal gap was associated to higher mean score
of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969;
P < 0.001). The mean score of RAVI between “no presbylarynx” and “presbylarynx” groups
was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients
with presbylarynx, the presence of glottal gap was associated to a higher mean score
of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30
(rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate “no presbylarynx” from “presbylarynx”,
obtained by the Youden’ index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10.
RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict
glottal gap, obtained by the Youden’ index, were 9.5 for RAVI, 21 for VHI-30 and 7.5
for VHI-10.
Conclusion
The optimal cut-off points do discriminate “no presbylarynx” from “presbylarynx” were
3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity
and specificity, probably because it was designed specifically for vocal complaints
of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI,
21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without
glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10.
Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice,
because for elderly patients it is easier to answer. However, to predict endoscopic
signs of presbylarynx, RAVI should be preferred.
Key Words
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Article info
Publication history
Published online: December 28, 2020
Accepted:
December 14,
2020
Footnotes
Conflict of Interest: The authors declare that they have no conflict of interest.
Compliance with Ethical Standards: Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent: Informed consent was obtained from all individual participants included in the study.
Financial disclosure: The authors declare that they have no financial disclosure to declare.
Identification
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© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
