Dysphonia in the Elderly: A Comparison of Benign Etiologies of Hoarseness in Two Different Cultures

Abstract

Objective: The objective of this study was to review the benign causes of hoarseness in the elderly above 60 years of age and to compare them between the two different cultures of Switzerland and Turkey. Material and Method: 140 patients were enrolled in the study, 69 (37 males, 32 females; mean age 66 years) from Berne, Switzerland, and 71 (41 males, 30 females; mean age 63 years) from Izmir, Turkey. Results and Conclusions: In the Berne study group, the most common benign causes of hoarseness registered in the elderly above 60 years of age were vocal cord paralysis (n = 31; 45%) and functional dysphonia (n = 24; 35%). These were followed by benign vocal cord lesions such as Reinke edema, contact granuloma or laryngeal papilloma (n = 4; 6%) and presbyphonia (n = 4; 6%). Laryngopharyngeal reflux was found in 8 patients (12%), 7 of them with functional dysphonia. In the Izmir study group, the most common benign causes of hoarseness detected in the elderly were vocal cord lesions (n = 28; 39%) and vocal cord paralysis (n = 25; 35%). These were followed by functional dysphonia (n = 10; 14%) and presbyphonia (n = 8; 11%). Seven patients (10%) in the Izmir study group were suffering from laryngopharyngeal reflux; this was combined with benign vocal cord lesions or functional dysphonia. The high percentage of patients with vocal cord paralysis is presumed to be due to the consultation having taken place at a tertiary-care center. However, there is a notable difference in the etiologies of vocal cord paralysis between the two compared groups: the paralysis in the Berne group was caused by diagnostic or therapeutic procedures relating to bronchopulmonary malignancies, whereas it was caused by the disease itself in the Izmir group. Organic manifestations of vocal misuse and poor voice hygiene were more frequent in the Izmir group. It may be supposed that the patients in the Swiss group were more careful with their voices and/or consulted their ENT specialists on functional voice disorders before organic lesions developed.

`Short-Term Effectiveness of a Swallowing Exercise for the Elderly Using Day-Care Services

“…Both hoarseness and the RSST score as outcome measurements were significantly improved after intervention. Since hoarseness causes vocal fold bowing [41], functional dysphonia [42], or unilateral vocal fold paralysis among elderly people [41,42], the abovementioned result showed a recovery of vocal cord physical status or function. Furthermore, the RSST test is consisted of the oral function, the pharyngeal function and the coordination between swallowing and respiration.…”

“…We selected a pushing exercise with the simultaneous voice and a falsetto [i:] as new exercise intervention, especially focusing on the pharyngeal stage in the 5 swallowing stages. A pushing exercise and a falsetto [i:] lead to strengthen the closure force of the vocal cords and the movement of the larynx to prevent aspiration [19,41,42]. To assess symptom improvement after intervention, voice clarity and swallowing function tests were observed [19].…”

“…There are some reports in the literature of sarcopenia-like changes in the muscles of the upper aerodigestive tract [19][20][21] and the observed age-related changes in strength and functions [5,6]. Since sarcopenia is associated with age [42][43][44], the muscles related to the pharyngeal stage and respiration also have risks of sarcopenia [45]. Ongoing work is underway to generate novel interventions that are effective for diminishing sarcopenia and increasing muscle strength [46].…”

Ear, Nose and Throat Manifestations in Geriatrics

“…Chronic suppurative otitis media (CSOM) was the most common infectious disease, affecting 28 (8.8%) patients whereas presbyacusis was identified in 20 (6.3%) of the patients. Kandogen and Seifert (2002) conducted similar studies in their respective countries, Turkey and Switzerland which was published together. Their studies conducted between these two cultures revealed that laryngopharyngeal conditions were prominent in the old aged.…”