Dysphonia in the Elderly: A Comparison of Benign Etiologies of Hoarseness in Two Different Cultures

Abstract

Objective: The objective of this study was to review the benign causes of hoarseness in the elderly above 60 years of age and to compare them between the two different cultures of Switzerland and Turkey. Material and Method: 140 patients were enrolled in the study, 69 (37 males, 32 females; mean age 66 years) from Berne, Switzerland, and 71 (41 males, 30 females; mean age 63 years) from Izmir, Turkey. Results and Conclusions: In the Berne study group, the most common benign causes of hoarseness registered in the elderly above 60 years of age were vocal cord paralysis (n = 31; 45%) and functional dysphonia (n = 24; 35%). These were followed by benign vocal cord lesions such as Reinke edema, contact granuloma or laryngeal papilloma (n = 4; 6%) and presbyphonia (n = 4; 6%). Laryngopharyngeal reflux was found in 8 patients (12%), 7 of them with functional dysphonia. In the Izmir study group, the most common benign causes of hoarseness detected in the elderly were vocal cord lesions (n = 28; 39%) and vocal cord paralysis (n = 25; 35%). These were followed by functional dysphonia (n = 10; 14%) and presbyphonia (n = 8; 11%). Seven patients (10%) in the Izmir study group were suffering from laryngopharyngeal reflux; this was combined with benign vocal cord lesions or functional dysphonia. The high percentage of patients with vocal cord paralysis is presumed to be due to the consultation having taken place at a tertiary-care center. However, there is a notable difference in the etiologies of vocal cord paralysis between the two compared groups: the paralysis in the Berne group was caused by diagnostic or therapeutic procedures relating to bronchopulmonary malignancies, whereas it was caused by the disease itself in the Izmir group. Organic manifestations of vocal misuse and poor voice hygiene were more frequent in the Izmir group. It may be supposed that the patients in the Swiss group were more careful with their voices and/or consulted their ENT specialists on functional voice disorders before organic lesions developed.