Quantification of Vocal Fold Atrophy in Age‐Related and Parkinson's Disease‐Related Vocal Atrophy

Abstract

Objective Vocal fold atrophy (VFA) is associated with aging and Parkinson's disease (PD). Clinical diagnosis of VFA depends on several visual‐perceptual laryngostroboscopy findings that are inherently subjective. The purpose of this study was to use quantitative measurements to; (1) examine the relationships between VFA and dysphonia severity and (2) evaluate differences in VFA in patients with age‐related VFA versus PD. Methods Thirty‐six patients >60 years of age with VFA were included in this retrospective cohort study. Demographic information, medical history, Consensus Auditory‐Perceptual Evaluation of Voice (CAPE‐V), Voice Handicap Index‐10 (VHI‐10), and still images from the stroboscopic exam were obtained. Image J™ was used to measure VFA, including bowing index (BI), normalized glottal gap area, and normalized mucosal wave amplitude. Pearson's correlation was used to evaluate the relationship between VFA, CAPE‐V, and VHI‐10. t‐Tests and multivariate linear regression were used to compare VFA measures by dysphonia severity (CAPE‐V <30 vs. >30) and diagnosis (age‐related vocal atrophy [ARVA] and PD). Results BI was positively correlated with CAPE‐V. Patients with CAPE‐V >30 had a significantly larger BI compared to those with CAPE‐V <30. Patients with PD had significantly larger BI than those with ARVA. Diagnosis of PD also predicted a larger BI after controlling for age and CAPE‐V. Conclusion Quantitative measures supported an association between bowing severity and dysphonia severity in patients with PD and ARVA. A PD diagnosis significantly predicted more severe BI. These findings demonstrate the potential utility of BI. Quantitative VFA measures might also provide insight into the mechanisms of ARVA and dysphonia. Level of Evidence 3 Laryngoscope, 133:1462–1469, 2023

Utilizing novel recurrent laryngeal motor nerve conduction studies to characterize the aging larynx: A pilot study

“…Moving forward, there may be value in using USV or other functional measures to provide context to electrophysiologic changes observed in different experimental conditions. In humans, evaluation morphologic changes to the aging larynx, such as vocal fold bowing, have been correlated with dysphonia and neuromuscular disease 43 . Attempting to make a similar association in rats may be possible with the use of endoscopic laryngeal evaluation and may help link neurophysiologic changes with ARVA.…”

Quantitative Evaluation of Vocal Bowing Following Bilateral Thyroplasty in Age‐Related Vocal Atrophy

“…However, voice disorders are frequently multifactorial in the elderly population that may involve additional factors such as neurological conditions, hormonal changes, and systemic diseases. 9,12,17 Saint-Victor et al challenged this assumption by demonstrating no significant difference in thyroarytenoid muscle volume across multiple age groups in individuals without a history of laryngeal pathology. 17 Furthermore, disruption of vocal fold vibration amplitude may also contribute to these voice disorders in the absence of frank presbyphonia.…”

“…8,9 Neuromuscular changes may lead to loss of muscle bulk and tone, causing reduced vocal fold tension, incomplete closure, and reduced mucosal vibration. 9 Bowing may also be related to specific changes to the vocal fold mucosa, such as collagen deposition in the lamina propria, vascular deficits, or hormonal changes. [19][20][21] Multidimensional investigation into the neurophysiologic, histologic, and functional changes in ARVA are needed to fully understand the pathogenesis of this condition.…”

“…8 Vocal fold bowing may also be a useful measure of ARVA given its ease in quantifying and correlation with voice quality. 9 ARVA is sometimes treated surgically with bilateral medialization thyroplasty. The goal of this surgery is to improve glottal closure by medializing the vocal folds.…”

“…Persistent glottal incompetence during voicing is cited as a recognizable feature of ARVA that leads to loss of air during phonation and breathy vocal quality 8 . Vocal fold bowing may also be a useful measure of ARVA given its ease in quantifying and correlation with voice quality 9 …”