Laryngoscopy And Voice Assessments Of The Normal Aged

Objective To investigate the laryngeal morphologic characteristics,the results of voice subjective assessment and the voice acoustic and aerodynamic features of the normal aged, to discuss the value of laryngoscopic observation and the subjective and objective voice analyses in evaluating the aged larynx and voice.Methods 95 elderly(≥65 years) and 102 young and middle-aged(25-45years) normal subjects were respectively selected as experiment and control groups. All of the subjects were tested by visual analog scale(VAS), the simplified Chinese version of voice handicap index(VHI-13), GRBAS perceptual evaluation, the voice acoustic and aerodynamic analyses,and examined by rigid magnifying laryngoscope or electronic laryngoscope. The differences of objective voice assessment results between two groups were compared, the relationship between the state of glottic closure and the subjective and objective assessments was investigated and the association of dysphonia severity index(DSI) with subjective assessment indicators of the normal aged was analyzed.Results In this study, the laryngoscopy of the normal elderly mainly presented vocal fold atrophy and edema, glottic incompetence, hypertrophic ventricular fold, glottic deviation, etc. The subjective voice assessment of experiment group showed that the scores of VAS and VHI were increased, the scales of overall grade(G), roughness(R),breathiness(B) and asthenia(A) were slightly and moderately abnormal. Compared with the control group, fundamental frequency(F0) rose in the male while declined in the female; jitter, shimmer and mean flow rate(MFR) increased, but DSI and maximum phonation time(MPT) decreased, all of the differences were statistically significant(P < 0.05 or 0.01). The scales of G, B, A and MFR were significantly higher(P <0.01) in the aged with glottic incompetence than that in the completely closed subjects. In the aged group, DSI was associated with the scores of G, B and A(P <0.05), but not correlated with VAS and VHI(P>0.05).Conclusion Morphological characteristics of the old larynx mainly reveal atrophy and edema of vocal fold, glottic incompetence and hypertrophic ventricular fold. The results of voice assessment in the elderly are different from the young and middle-aged. The study suggests that we could combine the voice assessments with laryngoscopic observation to comprehensively evaluate the aged voice and provide a basis for the differentiation between physiological and pathological larynx and voice of the aged.