Abstract
Objectives
Age-related voice changes are characterized as breathy, weak and strained, and a deterioration
in vocal function in the elderly has been putatively linked to a reduced intensity
of speech. They contribute to undesirable voice changes known as presbyphonia. These
changes are caused by histological alterations in the lamina propria of the vocal
fold mucosa and atrophy of the thyroarytenoid muscle, as well as by decreased respiratory
support. There are several clinical studies on presbylarynx dysphonia showing the
effectiveness of voice therapy. However, physiological changes of the presbylarynx
following voice therapy have not been verified. The purpose of this prospective study
was to demonstrate the clinical effectiveness of voice therapy for rehabilitating
presbylarynx dysphonia, using vocal function assessments and thyroarytenoid muscular
activity detection on laryngeal electromyography (LEMG).
Methods
10 patients who were diagnosed with aged vocal fold atrophy from ages 60 to 87 years
(mean age: 72 years) underwent approximately 12 weeks of voice therapy, mainly using
forward-focused voice and vocal resistance training. Stroboscopic examination, aerodynamic
assessment, acoustic analysis, Voice Handicap Index (VHI)-10, and LEMG were performed
pre– and post–voice therapy. Vocal fold vibratory amplitude (VFVA) was measured by
image analysis from the stroboscopic examinations. Turns analysis during steady phonation
on LEMG was also assessed.
Results
Maximum phonation time, subglottic pressure, jitter, shimmer, VFVA, and VHI-10 significantly
improved after voice therapy. The number of turns per second on LEMG also significantly
increased.
Conclusion
Our data suggest that voice therapy may improve vocal function and thyroarytenoid
muscle activity in patients with aged vocal fold atrophy.
Key words
Abbreviations:
BI (bowing index), EMG (electromyography), LEMG (laryngeal EMG), MFR (mean flow rate), MUP (motor unit potential), PhoRTE (phonation resistance training exercises), TA (thyroarytenoid), VFE (vocal function exercises), VFVA (vocal fold vibratory amplitude), VHI (Voice Handicap Index)To read this article in full you will need to make a payment
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REFERENCES
- The aging voice: a review, treatment data and familial and genetic perspectives.Folia Phoniatr Logop. 2001; 53: 252-265
- Treatment success for age-related vocal fold atrophy.Laryngoscope. 2011; 121: 585-589
- Ageing of the vibratory tissue of human vocal folds.Acta Otolaryngol. 1989; 07: 428-433
- Age-related changes of elastic fibers in the superficial layer of the lamina propria of vocal folds.Ann Otol Rhinol Laryngol. 1997; 106: 44-48
- Age-related changes of collagenous fibers in the human vocal fold mucosa.Ann Otol Rhinol Laryngol. 2000; 111: 15-20
- Gender-related differences of hyaluronic acid distribution in the human vocal fold.Laryngoscope. 2000; 111: 907-911
- (In)Atrophy of the Vocal Fold.(ed)in: Sato K Functional Histoanatomy of the Human Larynx. Springer Singapore, Singapore2018: 317-328
- Dysphonia in the aging: physiology versus disease.Laryngoscope. 1992; 102: 139-144
- Quantitative analysis of videostroboscopic images in presbylarynges.Laryngoscope. 2001; 111: 2022-2027
- Aerodynamic changes as a result of vocal function exercises in elderly men.Laryngoscope. 2008; 118: 1900-1903
- Vocal function exercises for presbylaryngis: a multidimensional assessment of treatment outcomes.Ann Otol Rhinol Laryngol. 2010; 119: 460-467
- Voice therapy improves quality of life in age-related dysphonia: a case-control study.J Voice. 2008; 22: 70-74
- Preliminary data on 2 voice therapy interventions in the treatment of presbyphonia.Laryngoscope. 2014; 124: 1869-1876
- Phonation resistance training exercises (PhoRTE) with and without expiratory muscle strength training (EMST) for patients with presbyphonia: a noninferiority randomized clinical trial.J Voice. 2021;
- The effect of vocal function exercises on the voices of aging community choral singers.J Voice. 2012; 26: 672.e619-672.e627
- Multidimensional analysis on the effect of vocal function exercises on aged vocal fold atrophy.J Voice. 2015; 29: 638-644
- Immediate effect of sounded blowing exercise in the elderly voice.Jornal da Sociedade Brasileira de Fonoaudiologia. 2011; 23: 27-31
- Multidimensional analysis on the effect of vocal function exercises on aged vocal fold atrophy.J Voice. 2015; 29: 638-644
- Human muscle gene expression following resistance exercise and blood flow restriction.Med Sci Sports Exerc. 2008; 40: 691-698
- Insulin-like growth factor I in skeletal muscle after weight-lifting exercise in frail elders.Am J Physiol. 1999; 277: 135-143
- Acute effects of resistance exercise on muscle protein synthesis rate in young and elderly men and women.Am J Physiol. 1993; 265: E210-E214
- Efficacy of vocal function exercises as a method of improving voice production.J Voice. 1994; 8: 271-278
- Preliminary data on 2 voice therapy interventions in the treatment of presbyphonia.Laryngoscope. 2014; 124: 1869-1876
- Effects of voice therapy on laryngeal motor units during phonation in chronic superior laryngeal nerve paresis dysphonia.J Voice. 2018; 32: 729-733
- Effect of voice therapy using semioccluded vocal tract exercises in singers and nonsingers with dysphonia.J Voice. 2019; 34: 963.e1-963.e9
- The Voice Handicap Index (VHI)development and validation.Am J Speech Lang Pathol. 1997; 6: 66-70
- A phase I/II exploratory clinical trial for intracordal injection of recombinant hepatocyte growth factor for vocal fold scar and sulcus.J Tissue Eng Regen Med. 2018; 12: 1031-1038
- Vocal fold atrophy: quantitative glottic measurement and vocal function.Ann Otol Rhinol Laryngol. 1997; 106: 544-551
- The value of laryngeal electromyography in the evaluation of laryngeal motion abnormalities.J Voice. 2006; 20: 452-460
- Basic Aspects of the Electrodiagnostic Evaluation.Delmar Learning, Clifton Park, NY2003
- Laryngeal Electromyography.Delmar Learning, Clifton Park. NY2003
- Laryngeal electromyography.in: Sataloff R Professional voice: The science and art of clinical care. 3rd, Plural pub inc., San Diego2005: 395-424
- Major patterns of laryngeal electromyography and their clinical application.Laryngoscope. 1997; 107: 126-136
- Cricoarytenoid subluxation, computed tomography, and electromyography findings.Head Neck Surg. 1987; 9: 341-348
- Laryngeal Electromyography.Igaku-Shoin, NewYork1995
- Quantitative laryngeal electromyography: turns and amplitude analysis.Laryngoscope. 2010; 120: 2036-2041
- Automatic analysis of the EMG interference pattern.Electroencephalogr Clin Neurophysiol. 1983; 56: 672-681
- Quantitative electromyography improves prediction in vocal fold paralysis.Laryngoscope. 2012; 122: 854-859
- Diagnostic laryngeal electromyography: the wake forest experience 1995-1999. otolaryngol.Head Neck Surg. 2012; 124: 603-606
- Central control of breathing in mammals: neuronal circuitry, membrane properties, and neurotransmitters.Physiol Rev. 1995; 75: 1-45
- Activity of respiratory neurons in the rostral medulla during vocalization, swallowing, and coughing in guinea pigs.Neurosci Res. 2014; 80: 17-31
- American college of sports medicine position stand. exercise and physical activity for older adults.Med Sci Sports Exerc. 2009; 41: 1510-1530
- A physiological and acoustic study on voiced bilabial fricative/beta:/as a vocal exercise.J Voice. 1996; 10: 67-77
- Electroglottographic study of seven semi-occluded exercises: LaxVox, straw, lip-trill, tongue-trill, humming, hand-over-mouth, and tongue-trill combined with hand-over-mouth.J Voice. 2014; 28: 589-595
- Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings.J Speech Lang Hear Res. 2006; 49: 448-459
- Acoustic interactions of the voice source with the lower vocal tract.J Acoust Soc Am. 1997; 101: 2234-2243
- The physics of small-amplitude oscillation of the vocal folds.J Acoust Soc Am. 1988; 83: 1536-1552
- Acoustic impedance of an artificially lengthened and constricted vocal tract.J Voice. 2000; 14: 455-469
- Flow phonation.in: Stemple JCFL Voice Therapy: Clinical Case Studies. 3rd. Plural Publishing, Abingdon2010
Article info
Publication history
Published online: October 11, 2021
Accepted:
September 2,
2021
Publication stage
In Press Corrected ProofFootnotes
Conflict of interests: The authors declared no conflict of interests.
Identification
Copyright
© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
