Sex-and Age-Based Etiological Analysis of 2901 Patients With Dysphonia in a Japanese Tertiary Medical Institute

Published:September 06, 2022DOI:



      Societal aging is a grave concern in Japan, and its impact on voice clinics has not been investigated. This study aimed to clarify recent demographic features of geriatric dysphonia at a tertiary medical institute in Japan.

      Study Design

      Retrospective study.


      The medical records of 2901 patients newly referred to the Voice Outpatient Clinic of the University of Tokyo Hospital between 2003 and 2020 were analyzed for age, sex, and etiology.


      The mean ± standard deviation age of all patients was 53.2 ± 20.7 (median, 58; range, 0–95) years. The aging rate (ratio of patients aged ≥65 years) increased continuously during the study period, and the recent aging rate was the highest in the world (43%). However, its rate of increase has slowed over the past 10 years. The etiologies of dysphonia associated with the largest number of older patients were vocal fold immobility (32%), vocal fold atrophy (23%), and benign vocal fold lesions (11%). The highest aging rate was detected in patients with laryngeal cancer/leukoplakia, vocal tremor, vocal fold atrophy, sulcus vocalis, and vocal fold immobility.


      Societal aging substantially increased the aging rate of patients with dysphonia in a Japanese voice clinic. The incidence of vocal fold immobility and atrophy is expected to continue to increase, whereas that of benign vocal fold lesions is expected to decrease.

      Key Words

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        • Mallick AS
        • Garas G
        • McGlashan J
        • et al.
        Presbylaryngis: a state-of-the-art review.
        Curr Opin Otolaryngol Head Neck Surg. 2019; 27: 168-177
        • Roy N
        • Merrill RM
        • Gray SD
        • et al.
        Voice disorders in the general population: prevalence, risk factors, and occupational impact.
        Laryngoscope. 2005; 115: 1988-1995
        • Cohen SM.
        Self-reported impact of dysphonia in a primary care population: an epidemiological study.
        Laryngoscope. 2010; 120: 2022-2032
        • Bhattacharyya N.
        The prevalence of voice problems among adults in the United States.
        Laryngoscope. 2014; 124: 2359-2362
        • Morrison MD
        • Gore-Hickman P.
        Voice disorders in the elderly.
        J Otolaryngol. 1986; 15: 231-234
        • Hagen P
        • Lyons GD
        • Nuss DW.
        Dysphonia in the elderly: diagnosis and management of age-related voice changes.
        South Med J. 1996; 89: 204-207
        • Golub JS
        • Chen PH
        • Otto KJ
        • et al.
        Prevalence of perceived dysphonia in a geriatric population.
        J Am Geriatr Soc. 2006; 54: 1736-1739
        • Roy N
        • Stemple J
        • Merrill RM
        • et al.
        Epidemiology of voice disorders in the elderly: preliminary findings.
        Laryngoscope. 2007; 117: 628-633
        • Turley R
        • Cohen S.
        Impact of voice and swallowing problems in the elderly.
        Otolaryngol Head Neck Surg. 2009; 140: 33-36
        • Marino JP
        • Johns MM.
        The epidemiology of dysphonia in the aging population.
        Curr Opin Otolaryngol Head Neck Surg. 2014; 22: 455-459
        • Roy N
        • Kim J
        • Courey M
        • et al.
        Voice disorders in the elderly: a national database study.
        Laryngoscope. 2016; 126: 421-428
        • Rapoport S
        • Menier J
        • Grant N.
        Voice changes in the elderly.
        Otolaryngol Clin N Am. 2018; 51: 759-768
        • Mirza N
        • Ruiz C
        • Baum ED
        • et al.
        The prevalence of major psychiatric pathologies in patients with voice disorders.
        Ear Nose Throat J. 2003; 82: 808-814
        • Verndock-de-Leeuw IM
        • Mahieu HF.
        Vocal aging and the impact on daily life: a longitudinal study.
        J Voice. 2004; 18: 193-202
        • Coyle SM
        • Weinrich BD
        • Stemple JC.
        Shifts in relative prevalence of laryngeal pathology in a treatment-seeking population.
        J Voice. 2001; 3: 424-440
        • Van Houtte E
        • Van Lierde K
        • D'Haeseleer E
        • et al.
        The prevalence of laryngeal pathology in a treatment-seeking population with dysphonia.
        Laryngoscope. 2010; 120: 306-312
        • Martins RHG
        • do Amaral HA
        • Tavares ELM
        • et al.
        Voice disorders: etiology and diagnosis.
        J Voice. 2016; 30: 761.e1-761.e9
        • Mathew AS
        • Shilpa H.
        Geriatric dysphonia etiological analysis in a rural hospital in India.
        Indian J Otolaryngol Head Neck Surg. 2019; 71: 218-224
        • Applebaum J
        • Harun A
        • Davis A
        • et al.
        Geriatric dysphonia: characteristics of diagnoses in age-based cohorts in a tertiary voice clinic.
        Ann Otol Rhinol Laryngol. 2019; 128: 384-390
        • Jacks A
        • Kavookjian H
        • Kraft S.
        Comparative evaluation and management of dysphonia between adults <65 and ≥65 years of age.
        Otolaryngol Head Neck Surg. 2021; 165: 142-148
        • Takano S
        • Kimura M
        • Nito T
        • et al.
        Clinical analysis of presbylarynx-vocal fold atrophy in the elderly individuals.
        Auris Nasus Larynx. 2010; 37: 461-467
        • Mozzanica F
        • Ginocchio D
        • Barillari R
        • et al.
        Prevalence and voice characteristics of laryngeal pathology in an Italian voice therapy-seeking population.
        J Voice. 2016; 30: e13-e21
        • Johns MM.
        Update on the etiology, diagnosis, and treatment of vocal fold nodules, polyps, and cysts.
        Curr Opin Otolaryngol Head Neck Surg. 2003; 11: 456-461
        • Karkos PD
        • McCormick M.
        The etiology of vocal fold nodules in adults.
        Curr Opin Otolaryngol Head Neck Surg. 2009; 17: 420-423
        • Kendall K.
        Presbyphonia: a review.
        Curr Opin Otolaryngol Head Neck Surg. 2007; 15: 137-140
        • Yamauchi A
        • Imagawa H
        • Sakakibara K
        • et al.
        Vocal fold atrophy in a Japanese tertiary medical institute: statas quo of the most aged country.
        J Voice. 2014; 28: 231-236
        • Avellaneda JC
        • Allen JE.
        Vocal fold sulci - what are the current options for and outcomes of treatment ?.
        Curr Opin Otolaryngol Head Neck Surg. 2021; 29: 458-464
        • Ford CN
        • Inagi K
        • Khidr A
        • et al.
        Sulcus vocalis: a rational analytical approach to diagnosis and management.
        Ann Otol Rhinol Laryngol. 1996; 105: 189-200
        • Davids T
        • Klein AM
        • Johns MM.
        Current dysphonia trends in patients over the age of 65: in vocal atrophy becoming more prevalent?.
        Laryngoscope. 2012; 122: 332-335
        • Laura H
        • Rosenthal S
        • Benninger MS
        • et al.
        Vocal fold immobility: a longitudinal analysis of etiology over 20 years.
        Laryngoscope. 2007; 117: 1864-1870
        • Takano S
        • Nito T
        • Tamaruya N
        • et al.
        Single institutional analysis of trends over 45 years in etiology of vocal fold paralysis.
        Auris Nasus Larynx. 2012; 39: 597-600
        • Marcotullio D
        • Magliulo G
        • Pezone T.
        Reinke's edema and risk factors: clinical and histopathologic aspects.
        Am J Otolaryngol. 2002; 23: 81-84
        • Altman KW.
        Vocal fold masses.
        Otolaryngol Clin North Am. 2007; 40: 1091-1108
        • Byeon H
        • Lee Y.
        Laryngeal pathologies in older Korean adults and their association with smoking and alcohol consumption.
        Laryngoscope. 2013; 123: 429-433
        • Zhukhovitskaya A
        • Battaglia D
        • Khosla SM
        • et al.
        Gender and age in benign vocal fold lesions.
        Laryngoscope. 2015; 125: 191-196
      1. Yamauchi A, Imagawa H, Yokonishi H, et al. Gender- and age-stratified normative voice data in Japanese speaking subjects: analysis of sustained habitual phonations. J Voice [E-pub ahead of print]

      2. Yamauchi A, Imagawa H, Yokonishi H, et al. Sex and age stratified voice data in Japanese vocally healthy individuals: vocal capacity. J Voice. [E-pub ahead of print]

        • Cohen SM
        • Kim J
        • Roy N
        • et al.
        Prevalence and causes of dysphonia in a large treatment-seeking population.
        Laryngoscope. 2012; 122: 343-348
        • Steuer CE
        • El-Deiry M
        • Parks JR
        • et al.
        An update on larynx cancer.
        CA Cancer J Clin. 2017; 67: 31-50
        • Possamai V
        • Hartley B.
        Voice disorders in children.
        Pediatr Clin North Am. 2013; 60: 879-892
        • Bless DM
        • Welham NV.
        Characterization of vocal fold scar formation, prophylaxis and treatment using animal models.
        Curr Opin Otolaryngol Head Neck Surg. 2010; 18: 481-486
        • Friedrich G
        • Dikkers FG
        • Arens C
        • et al.
        Vocal fold scars: current concepts and future directions. Consensus report of the phonosurgery committee of the European laryngological society.
        Eur Arch Otorhinolaryngol. 2013; 270: 2491-2507