Understanding Treatment Choices by Patients with Presbylarynges

The purpose of the project was to determine if objective measures of glottal closure, supraglottic activity and degree of bowing from endoscopic images of patients with presbylarynges differentiated between: 1) those recommended for observation and those recommended for treatment; 2) those recommended for voice therapy and those recommended for surgical intervention; and 3) those who followed through on recommendations and those who did not. Additionally, self-evaluation ratings and acoustic/aerodynamic measures were analyzed to see if they supported these findings. The study consisted of 104 patients over 60 years of age seen at the Voice Treatment Center diagnosed with presbylarynges and no other laryngeal pathology. Of the 104 patients, 30 were observed, 39 were recommended for voice therapy, and 35 were recommended for surgical management, either injection augmentation or bilateral thyroplasty. Images were selected from endoscopic evaluation for measurement of glottal gap (incomplete closure), bowing, and false vocal fold (FVF) compression. For measurement of glottal gap, 2 images from stroboscopy during prolonged /i/ were selected. For ascertaining the degree of bowing, 2 endoscopy images during rest breathing were selected. For measurement of FVF compression, 2 endoscopy images during prolonged /i/ were selected. Normalized measures were determined using equations from various publications. For glottal gap, Normalized Glottal Gap Area (NGGA) was determined (Omari, Kacker, Slavit & Blaugrund, 1996). For bowing, Total Bowing Index (BI) was determined (Bloch & Behrman, 2001). For false vocal fold compression, Normalized True Vocal Fold Width (NTVFW) was determined (Stager, Bielamowicz, Regnell, Marullo, Gupta, & Barkmeier, 2001). Self-reported ratings and other measures included GFI, RSI, V-RQOL, and flow during vibration. Those recommended for treatment were more likely to have greater NGGA values (larger gaps) than those observed (p = 0.06). Those recommended for voice therapy had greater NTVFW (less FVF compression) than those recommended for surgical intervention (p = 0.025). Those who followed through with recommendations had smaller NGGA values (p = 0.025) than those who did not follow through. They also had smaller flows during vocal fold vibration (p = 0.024) (commensurate with smaller gap) and rated themselves as having more severe symptoms (GFI, p = 0.01; V-RQOL, p = 0.01). A combination of measures from endoscopic images and other self-rating measures may provide a rubric for who is more likely to follow through with treatment recommendations; degree of FVF compression may be an early indicator of glottal insufficiency