Clinical Assessment of Glottal Insufficiency in Age-related Dysphonia

Abstract

Incomplete glottal closure is one of the key clinical aspects of presbylarynx. The objective of the present study is to determine the diagnostic yield of several tests for the assessment of glottal competence in age-related dysphonia. Cross-sectional prospective. One hundred and four healthy patients 65 years and older with a maximum phonation time below 12 seconds for women and 15 seconds for men were included. The glottal closure was assessed with laryngostroboscopy, and this observation was used as gold standard. Continuous light endoscopy, s/z ratio, electroglottography, and aerodynamic analysis of voice were performed, and their accuracy parameters for the diagnosis of the glottal gap in this context were calculated. A spindle-shaped gap was observed in 47 cases. Sensitivity of vocal fold bowing to predict glottal gap in phonation was 93.6% with a negative likelihood ratio of 0.15. Specificity of s/z ratio was 91.4% with a positive likelihood ratio of 6.17. Electroglottography and aerodynamic measurements of voice resulted to be inaccurate for the diagnosis of glottal insufficiency in phonation. Conventional endoscopy and s/z ratio are good diagnostic tests for an initial assessment of glottal insufficiency in age-related dysphonia that would allow general otolaryngologists early identification and prompt treatment of this pathology.