Presbylarynx and Laryngeal Asymmetry as Predictors of Dysphonia in Patients 65 and Over

OBJECTIVES: Presbyphonia and presbylarynx are common in aging people. Presbylarynx and laryngeal asymmetry increase with age and are visible on videostroboscopy. The purpose of this study was to determine if findings of presbylarynx or overall laryngeal asymmetry could be linked with patient-reported dysphonia. METHODS: Two hundred exams of patients over 64 were included: 100 with and 100 without voice complaints. Their videostroboscopic exams were evaluated for presbylarynx and laryngeal asymmetry. RESULTS: Median age was 72 (65-95) and 127 (63.5%) were female. No videostroboscopic exam features distinguished the dysphonia patients from those without. The dysphonia group had a significantly higher VHI-10 (13 vs. 2) and lower BMI (26.5 vs. 28.3) than the non-dysphonia group but did not differ in age, gender, nor height. Gender, age, and height were associated with findings of presbylarynx but not with dysphonia. 146 (73%) had 3 findings of presbylarynx (bowing, vocal process prominence, and vocal process contact preceding midfold contact at adduction). 171 (85.5%) patients had overall laryngeal asymmetry, 166 (83%) had phase asymmetry, and 131 (65.5%) had asymmetric speed or range of motion of the vocal folds. Only 24 (12 in each group) displayed the triad of increased ventricular show, contralateral false vocal fold contraction, and interarytenoid cleft tilt consistent with possible neurogenic paresis. CONCLUSION: Neither presbylarynx nor laryngeal asymmetry was associated with dysphonia in patients age 65 and over. Pathologic presbyphonia remains a complaint without a universal distinguishing group of predictive features, complicating patient care and treatment.