Autopercepção da voz, audição e saúde geral no rastreio de distúrbio vocal em idosas / Self-perception of voice, hearing, and general health in screening for voice changes in older women

RESUMO Objetivo Verificar a associação de fatores sociodemográficos, do comportamento vocal, morbidades e autopercepção da voz, auditiva e de saúde geral de idosas com distúrbio vocal. Método Participaram 95 idosas com idades entre 60 e 84 anos (média 69,5). Realizou-se uma entrevista com apoio de um questionário estruturado contendo questões sociodemográficas, de saúde e do comportamento vocal. Utilizou-se o Protocolo para Rastreamento de Alterações Vocais em Idosos (RAVI) para identificar a presença de distúrbio vocal. Resultados Houve o predomínio de participantes com ensino médio completo e aposentadas. O número de idosas que apresentaram distúrbio vocal segundo o RAVI foi de 46,3%. Queixas relacionadas às sensações físicas como garganta seca, pigarro e coceira na garganta foram as mais presentes. O grupo de idosas com distúrbio vocal apresentou pior autopercepção da qualidade vocal, audição, saúde geral e maior frequência de infecções de vias aéreas superiores quando comparadas àquelas sem distúrbio vocal (p≤0,05). Conclusão Houve associação estatística entre a autoavaliação vocal mensurada pelo RAVI e a autopercepção da qualidade da voz, da audição, da saúde geral, inflamações de garganta, sinusite e alergias respiratórias.

ABSTRACT Purpose To verify the association between sociodemographic factors, vocal behavior, morbidities, and self-perception of voice, hearing, and general health in older women with voice disorders. Methods The sample had 95 older women aged 60 to 84 years (mean of 69,5). They were interviewed with a structured questionnaire on sociodemographic aspects, health, and vocal behavior. The Screening Protocol for Voice Disorders in Older Adults (RAVI) was used to identify the presence of voice disorders. Results Participants who had finished high school and were retired predominated. The number of older women with voice disorders according to RAVI was 46.3%. Physical sensations such as dry throat, throat clearing, and itchy throat were the most common complaints. The group of older women with voice disorders had worse self-perception of voice quality, hearing, and general health and a higher frequency of upper airway infections than those without voice disorders (p ≤ 0.05). Conclusion The vocal self-assessment measured with RAVI was statistically associated with self-perception of voice quality, hearing, general health, sore throat, sinusitis, and respiratory allergies.

Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial.

OBJECTIVES: Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone. STUDY DESIGN: Prospective, randomized, controlled, single-blinded, non-inferiority. MATERIALS AND METHODS: Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10. RESULTS: Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P < 0.001; PhoRTE + EMST M = -9.58, P < 0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm H2O, PhoRTE + EMST M = 32.63 cm H2O; P= 0.015). Some secondary acoustic and aerodynamic outcomes displayed trends toward improvement. CONCLUSION: This study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.

Concentration of Fibroblasts in the Vocal Fold of Elderly.

OBJECTIVE: To study the concentration of fibroblasts in the vocal folds of elderly people. MATERIAL AND METHODS: The vocal folds of 13 cadavers were removed and divided into two age groups: Control group: n-5, 18-40 years; Elderly group: n-8, ≥75 years). The vocal folds were dissected and prepared for immunohistochemical analysis using the SA100 antibody to fibroblasts. The sites analyzed were maculae flavae and medial (or vibrating) portion of the vocal folds. The AVsoft program was used to count the cells. RESULTS: A higher concentration of fibroblasts was identified in the maculae flavae of the larynx of young adults and in the medial portion of the vocal folds of the elderly. However, these results did not determine statistically significant differences, allowing us to conclude that there was no effect of age on the concentration of fibroblasts in the vocal folds. CONCLUSION: In the larynx of the elderly, the fibroblast population remains similar to the young adults, both in the maculae flavae and in the body of the vocal folds, possibly being responsible for the constant production of fibrous matrix in the lamina propria. Functional changes in these cells are probably more marked than quantitative ones.

Aerodynamic, Electroglottographic, and Acoustic Outcomes after Tube Phonation in Water in Elderly Subjects.

OBJECTIVE: The present study aimed at observing the influence of tube phonation into water on objective voice characteristics in elderly subjects. METHODS: Thirty elderly subjects with presbyphonia were randomly assigned to one of two voice exercise groups: (1) voice exercises with water resistance therapy at 4 and 8 cm of water depth (experimental group), and (2) voice exercises with vowel [a:]. Aerodynamic, electroglottographic, and acoustic voice assessments were conducted before and after exercises. RESULTS: The experimental group showed a significant increase in contact quotient, subglottic pressure (Psub), glottal resistance, and sound pressure level (SPL) when comparing the pre-post 8 cm and the post 4 cm-post 8 cm conditions. No significant differences were found for the control group. Moreover, significant differences for all variables (except for glottal airflow) when comparing condition post (for the control group) and condition post 8 cm (for the experimental group) were found. CONCLUSION: Tube phonation into water might improve vocal function in the geriatric population. This semioccluded vocal tract exercise seems to promote an increase in Psub and vocal fold adduction immediately after exercise. This in turn might cause an increase in SPL. The effect should become manifest when a deep level of submersion (e.g., 8 cm water) is used. Shallower submersion produced negligible or no effects.

Presbilaringe: revisión de la literatura / Presbylarynges: literature review

La voz senil o presbifonía es una condición que se produce por cambios fisiológicos que se generan con los años y que alteran el sistema fonatorio, a nivel de cartílagos, músculos, vías nerviosas y otras alteraciones estructurales lo que, en su conjunto, se denomina presbilaringe. El diagnóstico de presbifonía es un diagnóstico de exclusión, debiendo previamente descartarse causas patológicas de disfonia. En el presente artículo se realiza una revisión de presbilaringe, enfocándose en epidemiología, anatomía, fisiología, histología, diagnóstico y manejo.

The senile voice or presbyphonia it is a condition that is produced by physiological changes that affects the fonatory system in the cartilage, muscles, nerves and other structural alterations, the latter is what is called presbylarynx. Presbyphonia is a diagnosis of exclusion, other pathological causes of dysphonia must be previously ruled out. In this article we made a review of the literature on presbylarynx, focusing on epidemiology, anatomy, physiology, histology, diagnosis and treatment.

Scanning Electron Microscopy of the Presbylarynx.

OBJECTIVE: To describe the findings on the presbylarynx under scanning electron microscopy. STUDY DESIGN: Cadaver study. SETTING: Universidade Estadual Paulista (Botucatu, São Paulo, Brazil). SUBJECTS AND METHODS: Sixteen vocal folds were removed during necropsies and distributed into 2 age groups: control (n = 8; aged 30-50 years) and elderly (n = 8; aged 75-92 years). The right vocal fold was dissected, fixed in glutaraldehyde 2.5%, and prepared for scanning electron microscopy. The thickness of the epithelium was measured using a scandium morphometric digital program. RESULTS: In the control group, the epithelium had 5 to 7 overlapped cell layers, rare desquamation cells, and little undulation with protruding intercellular junctions. The lamina propria showed a uniform network of collagen and elastic fibers in the superficial layer. A dense network of collagen was identified in the deeper layer. In the elderly group, the epithelium was atrophic (2-3 cells), with more desquamation cells and intercellular junctions delimited by deep sulci. The epithelial thickness was lower in elderly than in controls (mean [SD], 221.64 [145.90] µm vs 41.79 [21.40] µm, respectively). The lamina propria had a dense and irregular distribution of collagen and elastic fibers in the superficial layer. In the deep layers, the collagen fibers formed a true fibrotic and rigid skeleton. CONCLUSION: Scanning electron microscopy identified several changes in the elderly larynx, differentiating it from the controls. These alterations are probably related to the aging process of the vocal folds. However, the exact interpretation of these findings requires additional studies, even to the molecular level, having the fibroblasts as targets.

Hyaluronic acid behavior in the lamina propria of the larynx with advancing age.

OBJECTIVES: To analyze the hyaluronic acid behavior in the lamina propria of the larynx with advancing age. STUDY DESIGN: Prospective study. SETTING: UNESP-Univ Estadual Paulista, Botucatu Medical School, Brazil. SUBJECTS AND METHODS: Thirty vocal folds were obtained at necropsy from 10 adult males (30-50 years old) and 20 geriatric males (10: 60-75 years old; 10: over 76 years old). Midmembranous vocal fold sections were subjected to immunohistochemical reactions. Digital imaging software (ImageJ) was used to quantify the hyaluronic acid distribution over the lamina propria of vocal folds, from superficial to deep layers. RESULTS: Hyaluronic acid distribution was homogeneous for the larynges, at both superficial and deep layers (41.6 and 38.5, respectively). For both 30- to 50-year-old men geriatric age groups, hyaluronic acid level was lower at both layers. CONCLUSION: Hyaluronic acid level in the lamina propria of the larynx of geriatric men decreases with advancing age at both layers of the lamina.