Correlation of Glottic Gap and Voice Impairment in Presbyphonia

Abstract

Objective/Hypothesis The objective of this study was to investigate the glottic gap area as a significant marker for the severity of presbyphonia as it relates to patient‐reported outcome measures (Voice Handicap Index‐10 [VHI‐10]) and stroboscopic findings. Study Design Retrospective case‐control study conducted in an academic tertiary voice center. Methods Patients seen at a tertiary voice clinic who were diagnosed with presbyphonia without other organic laryngeal pathology from January 2014 to December 2017 were included. Clinical data and laryngeal videostroboscopy videos were collected. Still images at the point of vocal process approximation during adduction were captured, and the glottic gap area was measured using ImageJ. These were compared to a control cohort. Correlations were made using Wilcoxon rank sum test, Mann–Whitney U test, and Pearson correlation coefficients. Results Thirty‐three patients were included. Inter‐rater reliability of glottic area measurement was strong (intraclass correlation coefficient = 0.73, P < .001). Compared to controls, presbyphonia patients had a larger glottic gap area (P < .001) and greater open‐phase quotient on laryngeal videostroboscopy (P < .001). Larger glottic gap area did not correlate with patient‐reported vocal function as measured by VHI‐10 (P = .79) and did not correlate with presence of secondary muscle tension dysphonia (P = .99). In the presbyphonia cohort, the glottic gap area did not correlate with age (P = .29). Conclusions Glottic gap area at the point of vocal process approximation during phonation can be reliably measured. Patients with presbyphonia have a larger glottic gap area and greater open‐phase quotient on stroboscopy, but these do not correlate with patient‐reported voice impairment or the presence of secondary muscle tension dysphonia (MTD). These data suggest that dysphonia severity in presbyphonia is not fully explained by a glottic gap or secondary MTD alone. Level of Evidence 4 Laryngoscope, 131:1594–1598, 2021

How do presbylarynx and presbycusis affect the Voice Handicap Index and the emotional status of the elderly? A prospective case–control study

“…failed to demonstrate a correlation between glottic gap area and Voice Handicap Index-10. 5,16,17 Our results showed that patients with presbylarynx had higher Voice Handicap Index-30 total scores, as well as higher functional, physical and emotional subdomain scores, which was also reported by Santos et al . 4 Moreover, if a spindle-shaped glottal gap was present, Voice Handicap Index scores were even higher.…”

Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia

“…Few studies focus exclusively on elderly patients with presbyphonia. McGarey et al 23 evaluated the glottic gap but not treatments. Hsiung and Pai 31 and van den Broek et al 37 evaluated AAI but included patients aged <30 years.…”

“…The resulting area was measured with the rod tool. This measurement technique is similar to the mechanism used by Woo 22 and McGarey et al 23 to measure the waveform of the glottic area during videostroboscopy.…”

De novo tissue formation using custom microporous annealed particle hydrogel provides long-term vocal fold augmentation

“…The inability to achieve any phonation in our animal model is associated with large glottic gaps. For each rabbit, the lengthcorrected unilateral maximal glottal area [21][22][23][24][25] (MGA) (Fig. 3c), representing glottic insufficiency, was subtracted from the bilateral MGA to give an area difference.…”