Functional Electrical Stimulation for Presbyphonia: A Prospective Randomized Trial

Abstract

The aim of this prospective study was to examine the effects of transcutaneous functional electrical stimulation (FES) in a group of elderly women with presbyphonia. Study Design: Prospective randomized study. Methods: Fourteen participants were enrolled prospectively and attributed randomly to two different treatment groups, where one group (n = 7) received 8 weeks of training (5 days a week), whereas the other group (n = 7) received 4 weeks of ineffective stimulation, followed by 4 weeks of effective training. Stimulation protocols were established during baseline examination and confirmed with endoscopy to ensure a glottal reaction. Numerous acoustical, vocal, patient-centered, and respiratory parameters were obtained at several time points. Results: Neither 4 weeks nor 8 weeks of functional electrical transcutaneous stimulation led to changes of vocal, acoustical, or respiratory parameters, apart from patient-centered items (Voice Handicap Index 12, Voice-Related Quality of Life), which improved over time. However, there were no differences between the two arms for both items. Conclusions: Transcutaneous FES over 4 weeks and 8 weeks did not lead to significantly improved objective voice and acoustical parameters, which could be caused by the fact that the muscles of interest cannot be targeted specifically enough. However, we found a significant improvement of subjective voice perception and voice-related quality of life in both groups. We explain this finding with an observer-expectancy effect secondary to the very time-consuming and elaborate study procedures.

Presbyphonia as an Individual Process of Voice Change

“…The epidemiology of voice disorders in old age indicates the existence of dysphonia in as much as 30% of the population. 3 Only 15%−20% of them seek medical help, while others treat voice disorders as part of the natural aging process. It should be emphasized that the rapidly growing population of the elderly will be associated with the need to extend the period of their professional activity.…”

“…The definition of Presbyphonia has not yet been established, and the speculum image of the larynx is nonspecific. 3 The cause of voice disorders in elderly people are morphological changes in the larynx which concern all layers of the lamina propria of the laryngeal mucosa and mainly consist in a reduction in the number of elastic fibers and an increase in collagen fibrils, especially within the superficial layer of the lamina propria. In addition, there is a reduction in the number of blood vessels in this layer and lesser folding of the basement membrane recorded in the ultramorphological evaluation using Transmission Electron Microscopy.…”

“…In men, in this age group, she described a significant increase in the number of collagen fibrils, fibroblasts with features of hydrocephalic degeneration, reduction of blood vessels with multiplication of their basal membranes, and slight folding of the basal epithelial membrane, which confirmed atrophy of the vocal folds. According to Gugatschka et al, 3 morphological changes in the area of lamina propria regard degeneration of elastic fibrils, especially in men, and the growth of collagen fibrils in both genders. The subject of the ongoing discussion is the differentiation of morphological changes in the larynx into pathological or physiological ones related to the aging process of the organism, as these boundaries are unclear.…”

“…Due to the lack of typical symptoms of voice disorders and the pathognomonic morphological image of the larynx, many diagnostic methods are used in the diagnosis of Presbyphonia. 3 Perceptual, visualization and acoustic methods are used in the diagnosis of voice quality disorders. 5,20−22 Voice perception assessment using GRBAS scale was used as a preliminary criterion in selecting examined group.…”

“…However, visualization methods such as endoscopy or laryngeal stroboscopy are of key importance in the diagnosis of clinical dysphonia. 24 According to Gugatschka et al, 3 in Presbyphonia, in addition to glottal insufficiency of various degrees, in the stroboscopic examination of the larynx, an abnormal amplitude of vibrations and disturbances in the periodicity of vibrations of vocal folds are observed. In…”