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Stratifying Presbylarynx: Characterization of its Three Types

  • Mariline Santos
    Correspondence
    Address correspondence and reprint requests to: Mariline Santos, Largo Professor Abel Salazar, Serviço de Cuidados Intensivos do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto Porto, Porto Portugal
    Affiliations
    Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal
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  • Susana Vaz Freitas
    Affiliations
    Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal

    Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Porto, Portugal
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  • Cecília Almeida e Sousa
    Affiliations
    Serviço de Otorrinolaringologia do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal
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  • Álvaro Moreira da Silva
    Affiliations
    Serviço de Cuidados Intensivos do Centro Hospitalar Universitário do Porto e Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Porto, Portugal
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Published:October 17, 2022DOI:https://doi.org/10.1016/j.jvoice.2022.09.019

      Summary

      Objectives

      To describe the clinical characteristics of each type of glottal configuration proposed in a classification that allows stratifying presbylarynx into three types: Type 0: there is no significant morphological alteration in glottal configuration. Type 1: two or more of the following endoscopic signs are present: atrophic vocal folds, vocal fold bowing, prominence of vocal processes, supraglottal hyperactivity, decreased amplitude (vocal fold edge stiffness without evidence of vocal post-traumatic scar), and tremor of laryngeal structures. Type 2: elderly patients with type 1 plus glottal insufficiency.

      Methods

      Prospective, observational, and cross-sectional study. Data regarding age, gender, type of glottal configuration, self-assessment regarding vocal complaints, as well as acoustic and audio-perceptive examination were collected.

      Results

      The study population included 306 subjects (180 females), and the mean age was 73.85. Type 0 was the most frequent (61%). A statistically significant association was found between type 0 and female subjects, as well as type 2 and male subjects. The mean age of the patients with type 0 was statistically lower than the mean age of the patients with type 1 or type 2. The mean score of self-assessment questionnaires of patients with type 2 was statistically higher than the mean score registered for patients with type 0 and type 1. The mean score of Jitter, Shimmer, and HNR in type 2 were statistically higher than in type 0 or type 1 (P < 0.05). The mean score of Maximum Phonation Time in type 2 was statistically lower than in type 0 or 1 (P < 0.001). Based on vocal complaints, 115 subjects (38%) had presbyphonia (46 males; 69 females), and the mean age was 75.97 years (SD = 6.98; range 65 – 97). Among subjects without presbyphonia (n = 191), type 0 was the most frequent (84%), followed by type 1 (15%) and type 2 (1%). Among subjects with presbyphonia (n = 115), type 1 was the most frequent (58%), followed by type 0 (23%) and type 2 (19%).

      Conclusions

      This study presented the clinical characterization of a classification that allows stratifying endoscopic laryngeal signs in elderly patients with presbyphonia. We believe this classification will enrich the diagnostic protocol of the aging voice and will improve the documentation of treatment outcomes.

      Key Words

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