Clinical Assessment of Elderly Vocal Folds by Laryngoscopy
Laryngoscopy is an effective examination for assessing the morphological features of age-related vocal folds. In addition, disease-associated changes in the vocal folds in elderly people can also be diagnosed. Vocal fold atrophy is commonly identified as
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Clinical Assessment of Elderly Vocal Folds by Laryngoscopy Yoichiro Sugiyama
Abstract Laryngoscopy is an effective examination for assessing the morphological features of age-related vocal folds. In addition, disease-associated changes in the vocal folds in elderly people can also be diagnosed. Vocal fold atrophy is commonly identified as vocal fold bowing, which is characterized as a concaved edge of the vocal folds. The other typical disorder caused by atrophic changes in age-related vocal folds is sulcus vocalis. These changes are attributed to the volume reduction and degeneration of the extracellular matrix in the lamina propria in addition to atrophy of the intralaryngeal muscles. Stroboscopy is a useful and reliable method for examining vocal fold vibration. The reduced amplitude, aperiodic, and asymmetric vibration as along with the glottal gap are generally observed in elderly people with vocal fold atrophy. As such, both laryngoscopy and stroboscopy are better techniques not only to diagnose age-related vocal fold disorders, but also to evaluate disease-specific treatment.
5.1 Laryngoscopic Examination Laryngoscopy using a flexible fiberscope or a rigid telescope is a valuable assessment of anatomical and physiological characteristics of vocal folds in patients who suffered from phonatory problems. In particular, laryngoscopy can visualize not only detailed morphological features of age-related vocal folds, but could also provide a clinical diagnosis of the laryngeal lesion, including benign or malignant laryngeal neoplasms using narrow band imaging [1, 2]. In addition, vocal fold dysfunction, such as vocal fold paralysis and vocal fold dyskinesia, which causes hoarseness or dysphonia, can also be assessed by the examination. Aging influences various vocal tract organs, as mentioned in Chap. 1. With regard to phonation, many age-related changes, possibly including additional
Y. Sugiyama Department of Otolaryngology-Head and Neck Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan e-mail: [email protected] © Springer Nature Singapore Pte Ltd. 2017 K. Makiyama, S. Hirano (eds.), Aging Voice, DOI 10.1007/978-981-10-3698-9_5
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d isorders in elderly patients, could occur [3]. Vocal fold atrophy is attributed to agerelated alteration of mucosal and submucosal tissue [4–6]. For example, the thickening of the basement membrane and the thinning of the lamina propria occur in sulcus vocalis, therefore glottal gaps and irregular vibrations would be observed [7]. Otherwise, gender differences can influence the age-related structural alteration of the vocal folds, at least in part, resulting in distinct trends of age-related vocal change [4]. Moreover, during the process of aging, the microstructures of the intralaryngeal muscles, including the thyroarytenoid muscle by which the vocal folds strongly adduct during vocalization, change, and the attenuation of activity of those muscles, can occur [8, 9]. These anatomical and functional changes with the aging process would
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