Weekly Teaching Tip – Feb. 9, 2015

Presbylaryngis refers to age related structural changes of the vocal folds. As we age it is normal to experience some degree of vocal fold atrophy and elasticity. With reduction of all androgenic hormones as well as estrogen the vocal folds lose muscle mass and moisture. In the laryngology side of my practice this is the most common condition seen and presents with dysphonia, throat clearing, and in severe cases even aspiration. The patients will complain of vocal fatigue as the day progresses and singers begin to lose their usual range. As women age the pitch of their voice becomes deeper and for men their pitch becomes higher.

On examination with laryngoscopy and videostroboscopy bowing is seen and sometimes there is asymmetry and increased amplitude. The larynx frequently compensates with increased tension to overcome bowing and asymmetry.

Treatment consists of voice therapy with strengthening and stretching exercises and fluids. When glottal insufficiency is present and coughing and aspiration is a problem injection laryngoplasty is helpful. There are several substances that are used for injection; Fat, Cimetra, and Calcium hydroxlapatite. I prefer the later because there is no preparation or mixing. This procedure is performed in the office or operating room; this is mostly dependent on the patient and gag reflex. The actual procedure takes approximately 15 minutes. Patients at the Voice Center usually receive several voice therapy sessions prior to considering injection. As with most vocal issues think therapy first and then surgery.

Curt R Stock MD

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