Aging thyroarytenoid and limb skeletal muscle: lessons in contrast

Age and sex-related variations in murine laryngeal microbiota

The larynx undergoes significant age and sex-related changes in structure and function across the lifespan. Emerging evidence suggests that laryngeal microbiota influences immunological processes. Thus, there is a critical need to delineate microbial mechanisms that may underlie laryngeal physiological and immunological changes. As a first step, the present study explored potential age and sex-related changes in the laryngeal microbiota across the lifespan in a murine model. We compared laryngeal microbial profiles of mice across the lifespan (adolescents, young adults, older adults and elderly) to determine age and sex-related microbial variation on 16s rRNA gene sequencing. Measures of alpha diversity and beta diversity were obtained, along with differentially abundant taxa across age groups and biological sexes. There was relative stability of the laryngeal microbiota within each age group and no significant bacterial compositional shift in the laryngeal microbiome across the lifespan. There was an abundance of short-chain fatty acid producing bacteria in the adolescent group, unique to the laryngeal microbiota; taxonomic changes in the elderly resembled that of the aged gut microbiome. There were no significant changes in the laryngeal microbiota relating to biological sex. This is the first study to report age and sex-related variation in laryngeal microbiota. This data lays the groundwork for defining how age-related microbial mechanisms may govern laryngeal health and disease. Bacterial compositional changes, as a result of environmental or systemic stimuli, may not only be indicative of laryngeal-specific metabolic and immunoregulatory processes, but may precede structural and functional age-related changes in laryngeal physiology.

Neurophysiology of the Superior Laryngeal Nerve in an In Vivo Rat Model

OBJECTIVE

The superior laryngeal nerve (SLN) is fundamental in laryngeal sensation, cough reflex, and pitch control. SLN injury has substantial consequences including altered sensation, aspiration, and dysphonia. To date, in vivo measurement of the SLN remains elusive. The purpose of this study was to assess the feasibility of recording motor and sensory evoked potentials in a rat SLN model.

METHODS

Twenty-two rat hemi-laryngeal preparations (n = 11) were obtained from 4-month-old Sprague-Dawley rats and included in this study. Compound motor action potentials (CMAPs) and motor unit number estimation (MUNE) were calculated by stimulating the SLN at the point of medial extension near the carotid artery and by placing a recording electrode on the cricothyroid muscle. Sensory response was determined through stimulation of the SLN and laryngoscopic visualization of a laryngeal adductor reflex (LAR). SLN and cricothyroid muscle cross-sections were stained and histologic morphometrics were quantified.

RESULTS

Laryngeal evoked potentials were successfully obtained in all trials. Mean CMAP latency and negative durations were 0.99 ± 0.57 ms and 1.49 ± 0.57 ms, respectively. The median MUNE was 2.06 (IQR 1.88, 3.51). LAR was induced with a mean intensity of 0.69 ± 0.20 mV. Mean axon count, myelin thickness, and g-ratio were 681 ± 192.2, 1.72 ± 0.26, and 0.45 ± 0.04, respectively.

CONCLUSIONS

This study demonstrates the feasibility of recording evoked response potentials following SLN stimulation. We hypothesize that this work will provide a tractable animal model to study changes in laryngeal sensation and cricothyroid motor function with aging, neurodegenerative disease, aspiration, or nerve injury.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:1778-1784, 2024.

Geriatric Voice: Distinctive Clinical Profiles of Working Seniors in a Tertiary Laryngology Clinic

OBJECTIVES

Voice disorders have been reported in up to 47% of the geriatric population. Few studies have assessed dysphonia in the elderly, with none examining vocal function in working seniors. This study aims to profile the clinical characteristics of individuals aged 65 years and older, comparing working and non-working seniors.

STUDY DESIGN

Retrospective cohort study.

METHODS

Medical charts were reviewed for patients aged 65 years and older referred to the McGill University Health Centre Laryngology Clinic (January 2018-March 2020). Variables studied included sociodemographics, comorbidities, voice complaints, lifestyle factors, diagnoses, voice acoustics [maximum phonation time (MPT), S/Z ratio, F0], GRBAS scale, Voice Handicap Index-10 (VHI-10), Reflux Symptom Index (RSI), and treatment modalities.

RESULTS

A total of 267 patients were included, with a mean [standard deviation (SD)] age of 74.2 (6.6) years and 61% of female patients. Occupation information was available in 148 cases, of which 31.1% were still working and 12.8% were professional voice users. The predominant voice complaint was dysphonia/hoarseness (48.8%) and the most prevalent diagnosis was presbyphonia (31.8%). The mean (SD) VHI-10 and RSI scores were 19.8 (9.0) and 18.7 (9.4) points, respectively. Voice therapy was prescribed for 155 patients (58.7%): 124 attended at least one session with significant post-treatment improvements in the GRBAS and VHI-10 scores (P < 0.01). In the univariate analysis, working seniors had a significantly more prevalent singing habit (P = 0.04) and laryngopharyngeal reflux diagnosis (P = 0.01), displaying a significantly longer MPT (P < 0.001) and lower G-B-S scores (P < 0.05). After adjusting mean differences, only MPT and the G-S scores were significantly different between both groups.

CONCLUSIONS

The predominant diagnosis in elders with voice complaints was presbyphonia. Voice therapy proved effective in improving the VHI-10 and GRBAS scores for geriatric patients. Almost one-third of seniors remained in the workforce, demonstrating superior vocal profiles, specifically in the MPT and the grade and strain of perceptual voice quality.

Ultrasound Elastography Detects Age-Related Changes in Adult False Vocal Folds

PURPOSE

To investigate the feasibility of ultrasound elastography for assessing the symmetry in stiffness values and movements of both false vocal folds (FVFs).

METHODS

After Institutional Review Board's approval and written informed consent obtained, we measured ultrasound strain and shear wave velocity (SWV) of the bilateral FVF in vocal fold abduction and adduction in 30 participants using a linear array transducer (4-10 MHz). Twenty-eight participants met inclusion criteria as healthy subjects for analysis. Mean strain of FVF produced by FVF movement from abduction to adduction was analyzed using 2D speckle-tracking software offline. A SWV ratio ([SWV_adduction - SW_abduction ]/SW_abduction ) was developed to test the contractibility of FVF. Statistical analysis included one-way ANOVA to test the difference in mean strain, SWV (adduction and abduction), and SWV ratio among the three age groups; linear regression to analyze correlations of stiffness and movement between the right and left FVF; and intraclass correlation coefficient (ICC) to examine intra- and interobserver reliability in performing shear wave elastography (SWE) of FVF.

RESULTS

The 28 healthy participants were divided into 3 age groups (10 of young 20-44 years; 9 of mid-age 45-64 years; and 9 of senior ≥65 years). The SWV in FVF abduction was higher and the SWV ratio was lower in seniors compared to young participants (P < .05). Good to excellent correlation of mean strain and SWV between both FVFs (R²  > 0.89). The reliability of performing SWE of FVF was moderate to excellent.

CONCLUSION

Ultrasound elastography is feasible to assess the stiffness, dynamic movement, and symmetry of adult FVF, and healthy seniors may exhibit increased FVF stiffness.

Subjective voice change was associated with appendicular skeletal muscle mass in elderly men, but not in women: A cross-sectional study

OBJECTIVES

To investigate the relationship between subjective voice changes and appendicular skeletal muscle in the elderly in Korea.

DESIGN

Retrospective cross-sectional study.

SETTING

Population-based survey data were collected by the Korean National Health and Nutrition Examination Survey between January 2009 and December 2011.

PARTICIPANTS

A total of 2611 participants (1081 men and 1530 women) aged 65 to 80 years were enrolled in the Korean National Health and Nutrition Examination Survey from 2009 to 2011. A 70-degree laryngeal endoscopy was performed to check for abnormalities in the larynx, while dual-energy x-ray absorptiometry was utilised to measure appendicular skeletal muscle mass. The correlation between subjective voice change and appendicular skeletal muscle index (ASMI) was analysed using a linear-by-linear association test and logistic regression analysis.

RESULTS

When comparing ASMI according to the presence or absence of subjective voice change, elderly men showed significantly lower ASMI values when subjective voice change was present (p = .021). However, in women, the ASMI was not significantly lower in the presence of subjective voice changes (p = .365). We confirmed that subjective voice change was significantly lower in the highest quintile of ASMI compared to lowest quintile of ASMI in the men using logistic regression analysis (B 0.281, 95% confident interval 0.082-0.964, p < .044).

CONCLUSIONS

This study has shown that in Korean men aged >65 years, subjective voice abnormality significantly increased as skeletal muscle mass decreased. Further longitudinal studies are needed to determine whether a correlation exists between objective voice test results and ASMI.

Diferencias en el comportamiento glótico y supraglótico y en la estructura de los pliegues vocales entre mujeres con odinofonía y asintomáticas

El estudio de la odinofonía ha sido escasamente abordado por las disciplinas vinculadas a la terapéutica vocal. La comprensión de aspectos esenciales para su terapéutica, como el comportamiento glótico y supraglótico, aún es emergente. El objetivo de este trabajo fue comparar el comportamiento glótico y supraglótico y la estructura de los pliegues vocales entre mujeres con odinofonía yasintomáticas. Se trabajó con 50 mujeres con voces profesionales, cuya edad promedio fue de 25,78 ± 3,50 años. Se formaron dos grupos, G1 (asintomáticas) y G2 (con odinofonía). Se utilizó un videolaringoscopio con luz continua para examinar la conducta supraglótica y la estructura cordal, y un electroglotógrafo para analizar el comportamiento de los pliegues vocales. En el comportamiento supraglótico, el 64 % de las participantes de G2 exhibió mayor compresión supraglótica en comparación a G1. El acortamiento anteroposterior en conjunto a la compresión medial fue la configuración más frecuente en G2, mientras que el acortamiento anteroposterior en solitario, correspondió a la configuración supraglótica más frecuente en G1. En el 60 y 84 % de las participantes de G2 se observó prominencia del proceso vocal y ventrículo espacioso junto a un pliegue vocal adelgazado, respectivamente. En la electroglotografía se evidenció que en G1 el cociente de contacto fue de 0,50 ± 0,34 y en G2, de 0,41 ± 0,31 (p < 0,05). En conclusión, en las mujeres que sufren de odinofonía se observaron signos de atrofia cordal, mientras que en oscilación se evidenciaron compresiones supraglóticas compensatorias y anomalías vinculadas a la aproximación o aducción cordal.

Predicting frailty in older adults using vocal biomarkers: a cross-sectional study

BACKGROUND

Frailty is a common issue in the aging population. Given that frailty syndrome is little discussed in the literature on the aging voice, the current study aims to examine the relationship between frailty and vocal biomarkers in older people.

METHODS

Participants aged ≥ 60 years visiting geriatric outpatient clinics were recruited. They underwent frailty assessment (Cardiovascular Health Study [CHS] index; Study of Osteoporotic Fractures [SOF] index; and Fatigue, Resistance, Ambulation, Illness, and Loss of weight [FRAIL] index) and were asked to pronounce a sustained vowel /a/ for approximately 1 s. Four voice parameters were assessed: average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4).

RESULTS

Among 277 older adults, increased A1 was associated with a lower likelihood of frailty as defined by SOF (odds ratio [OR] 0.84, 95% confidence interval [CI] 0.74-0.96). Participants with larger A2 values were more likely to be frail, as defined by FRAIL and CHS (FRAIL: OR 1.41, 95% CI 1.12-1.79; CHS: OR 1.38, 95% CI 1.10-1.75). Sex differences were observed across the three frailty indices. In male participants, an increase in A3 by 10 points increased the odds of frailty by almost 7% (SOF: OR 1.07, 95% CI 1.02-1.12), 6% (FRAIL: OR 1.06, 95% CI 1.02-1.11), or 6% (CHS: OR 1.06, 95% CI 1.01-1.11). In female participants, an increase in A4 by 0.1 conferred a significant 2.8-fold (SOF: OR 2.81, 95% CI 1.71-4.62), 2.3-fold (FRAIL: OR 2.31, 95% CI 1.45-3.68), or 2.8-fold (CHS: OR 2.82, 95% CI 1.76-4.51, CHS) increased odds of frailty.

CONCLUSIONS

Vocal biomarkers, especially spectral-domain voice parameters, might have potential for estimating frailty, as a non-invasive, instantaneous, objective, and cost-effective estimation tool, and demonstrating sex differences for individualised treatment of frailty.

Proteomic Characterization of Senescent Laryngeal Adductor and Plantaris Hindlimb Muscles

OBJECTIVES

The goals of this study were to 1) compare global protein expression in muscles of the larynx and hindlimb and 2) investigate differences in protein expression between aged and nonaged muscle using label-free global proteomic profiling methods.

METHODS

Liquid chromatography-mass spectrometry (LC-MS/MS) analysis was performed on thyroarytenoid intrinsic laryngeal muscle and plantaris hindlimb muscle from 10 F344xBN F1 male rats (5 old and 5 young). Protein expression was compared and pathway enrichment analysis performed for each muscle type (larynx and limb) and age group (old and young muscle).

RESULTS

Over 1,000 proteins were identified in common across both muscle types and age groups using LC-MS/MS analysis. Significant age-related differences were seen across 107 proteins in plantaris hindlimb and in 19 proteins in thyroarytenoid laryngeal muscle. Bioinformatic and enrichment analysis demonstrated protein differences between the hindlimb and larynx may relate to immune and stress redox responses and RNA repair.

CONCLUSION

There are clear differences in protein expressions between the laryngeal and hindlimb skeletal muscles. Initial analysis suggests differences between the two muscle groups may relate to stress responses and repair mechanisms. Age-related changes in the thyroarytenoid appear to be less obvious than in the plantaris. Further in-depth study is needed to elucidate how aging affects protein expression in the laryngeal muscles.

LEVEL OF EVIDENCE

NA Laryngoscope, 132:148-155, 2022.

Phonation Resistance Training Exercises (PhoRTE) With and Without Expiratory Muscle Strength Training (EMST) For Patients With Presbyphonia: A Noninferiority Randomized Clinical Trial

OBJECTIVES

Presbyphonia negatively impacts quality of life in patients with age-related voice changes. A proof-of-concept study showed promise for high vocal intensity exercise to treat presbyphonia, which became the basis for a novel intervention for age-related voice changes known as Phonation Resistance Training Exercises (PhoRTE). Expiratory Muscle Strength Training (EMST) has also been proposed as an additional intervention to target and strengthen the aging respiratory system; however, EMST has undergone limited evaluation as an adjunct treatment for elderly patients undergoing voice therapy for presbyphonia. This study determined if the addition of EMST to PhoRTE voice therapy (PhoRTE + EMST) is at least as effective at voice improvement as PhoRTE alone.

STUDY DESIGN

Prospective, randomized, controlled, single-blinded, non-inferiority.

MATERIALS AND METHODS

Participants aged 55 years or older with a diagnosis of vocal fold atrophy were randomized to complete PhoRTE therapy or PhoRTE + EMST. The primary outcome was change in Voice Handicap Index-10 (VHI-10). Secondary outcomes included the Aging Voice Index, maximum expiratory pressure, and acoustic and aerodynamic measures of voice. Repeated measures linear mixed models were constructed to analyze outcomes at a significance level of α = 0.10.

RESULTS

Twenty-six participants were recruited for the study, and 24 participants were randomized to either treatment arm. Sixteen participants completed the entire study. Both treatment arms showed statistically significant and clinically meaningful improvements in VHI-10 (PhoRTE mean [M] = -8.20, P < 0.001; PhoRTE + EMST M = -9.58, P < 0.001), and PhoRTE + EMST was noninferior to PhoRTE alone (P = 0.069). Both groups experienced a statistically significant pre-post treatment decrease (improvement) in AVI scores (PhoRTE M = -18.40, P = 0.004; PhoRTE + EMST M = -16.28, P = 0.005). PhoRTE+EMST had statistically significantly greater changes in maximum expiratory pressure compared to PhoRTE alone (PhoRTE M = 8.24 cm H₂O, PhoRTE + EMST M = 32.63 cm H₂O; P= 0.015). Some secondary acoustic and aerodynamic outcomes displayed trends toward improvement.

CONCLUSION

This study demonstrates that voice therapy targeting high vocal intensity exercise (eg, PhoRTE) and EMST can play a role in improving voice outcomes for patients with presbyphonia.

Neuromuscular Specializations of the Human Hypopharyngeal Muscles

The hypopharyngeal muscles in humans play a vital role in swallowing, speech, and respiration. Increasing evidence indicates that these muscles are specialized to perform life-sustaining upper aerodigestive functions. This review aims to provide current knowledge regarding the key structural, physiological, and biochemical features of the hypopharyngeal muscles, including innervation, contractile properties, histochemistry, biochemical properties, myosin heavy chain (MyHC) expression and regulation, and age-related alterations. These would clarify the unique neuromuscular specializations of the human hypopharyngeal muscles for a better understanding of the functions and pathological conditions of the pharynx and for the development of novel therapies to treat related upper airway disorders.

An exploratory model of speech intelligibility for healthy aging based on phonatory and articulatory measures

PURPOSE

The aims of the current study were to determine age-related changes to the phonatory and articulatory subsystems and to investigate an exploratory model of intelligibility for healthy aging based on phonatory and articulatory measures.

METHOD

Fifteen healthy, older adults (55-81 years) and 15 younger adults (20-35 years) participated in instrumental assessments of the phonatory (aerodynamic, acoustic) and articulatory (kinematic) subsystems. Speech intelligibility was determined by five listeners during multi-talker babble.

RESULTS

Older adults displayed shorter maximum phonation time, greater airflow during sentence reading, and lower cepstral peak prominence (CPP) and CPP SD. Additionally, older adults had slower tongue movement speed than younger adults. Speech intelligibility was also significantly reduced in the older group. A generalized estimating equations model combining phonatory and articulatory measures showed that CPP SD, low/high (L/H) spectral ratio mean and SD, Cepstral Spectral Index of Dysphonia (CSID), and maximum tongue movement speed were significant contributors to intelligibility changes in older individuals. While L/H mean and SD and CSID displayed an inverse relationship with intelligibility, CPP SD and maximum tongue speed displayed a direct relationship with intelligibility.

DISCUSSION

Aging affects the phonatory and articulatory subsystems with implications for speech intelligibility. Phonatory cepstral/spectral measures (except mean CPP) were associated with speech intelligibility changes, suggesting that changes in voice quality may contribute to reduced intelligibility in older adults. Pertaining to articulation, slower tongue movement speed likely contributed to reduced intelligibility in older individuals.

The Effects of Menopause on Neuromuscular Parameters of the Rat Vocal Folds

OBJECTIVES/HYPOTHESIS

Menopause adversely affecs power and endurance of the limb muscles. However, despite clinical observations that menopause corresponds to negative changes of the voice, the direct effects of estrogen deprivation on the thyroarytenoid muscles are unknown. The purpose of this study was to investigate the effects of estrogen deprivation via ovariectomy on three neuromuscular parameters of the thyroarytenoid muscles using a rat model.

STUDY DESIGN

Animal model.

METHODS

Cryosections of vocal folds of 20 (10 control and 10 ovariectomized) female rats were stained to label neuromuscular junctions, fiber size, or parvalbumin levels using immunohistochemical techniques and compared between experimental groups.

RESULTS

The neuromuscular junctions, thyroarytenoid fiber sizes, and parvalbumin levels of the vocal folds were similar between experimental groups.

CONCLUSIONS

The loss of estrogen did not change neuromuscular parameters of the vocal folds of adult female rats; therefore, vocal changes within the outer vibratory layers of the vocal folds may primarily be responsible for clinically observed menopausal vocal changes.

LEVEL OF EVIDENCE

NA Laryngoscope, 131:1343-1348, 2021.

Volumetric Analysis of the Vocal Folds Using Computed Tomography: Effects of Age, Height, and Gender

OBJECTIVE

The goal of this study was to use computed tomography (CT) volumetric analysis to assess the effect of age, gender, height, body mass index (BMI), and ethnicity on vocal fold volume in patients with normal larynges.

STUDY DESIGN

Retrospective cross-sectional study.

METHODS

Vocal fold length, width, and height were measured in a total of 105 patients without a history of laryngeal or thyroid pathology on thin-section soft-tissue neck CTs. The product of the three dimensions was used to calculate vocal fold volume. Simple and multiple linear regression analyses were used to assess for an association between vocal fold volume and age, gender, height, BMI, and ethnicity. Intraclass correlation coefficients (ICCs) were estimated to evaluate the degree interobserver and intraobserver agreement.

RESULTS

Vocal fold volume was not associated with age, BMI, or ethnicity. Gender-adjusted height (P = .002) and height-adjusted gender (P = .016) were significantly associated with volume. Height remained significantly associated with volume after stratifying by gender (P < 0.001). There was moderate-to-good correlation in both interobserver (ICC = 0.690 to 0.761) and intraobserver (ICC = 0.733 to 0.873) agreement.

CONCLUSION

Age was not associated with vocal fold volume, which is in accordance with several prior negative studies. Age-related vocal fold atrophy may not substantially contribute to presbyphonia symptoms, but other processes such as changes in the extracellular matrix may play a larger role. However, both gender and height were independently associated with vocal fold volume.

LEVEL OF EVIDENCE

4 Laryngoscope, 131:E240-E247, 2021.

Vocal Feminization for Transgender Women: Current Strategies and Patient Perspectives

Voice feminization for transgender women is a highly complicated comprehensive transition process. Voice feminization has been thought to be equal to pitch elevation. Thus, many surgical procedures have only focused on pitch raising for voice feminization. However, voice feminization should not only consider voice pitch but also consider gender differences in physical, neurophysiological, and acoustical characteristics of voice. That is why voice therapy has been the preferred choice for the feminization of the voice. Considering gender difference of phonatory system, the method for voice feminization consists of changing the following four critical elements: fundamental frequency, resonance frequency related to vocal tract volume and length, formant tuning, and phonatory pattern. Voice feminizing process can be generally divided into non-surgical feminization and surgical feminization. As a non-surgical procedure, feminization voice therapy consists of increasing fundamental frequency, improving oral and pharyngeal resonance, and behavioral therapy. Surgical feminization usually can be achieved by external approach or endoscopic approach. Based on three factors (length, tension and mass) of vocal fold for pitch modulation, surgical procedure can be classified as one-factor, two-factors and three-factors modification of vocal folds. Recent systematic reviews and meta-analysis studies have reported positive outcomes for both the voice therapy and voice feminization surgery. The benefits of voice therapy, as it is highly satisfactory, mostly increase vocal pitch, and are noninvasive. However, the surgical voice feminization of three-factors modification of vocal folds is also highly competent and provides a maximum absolute increase in vocal pitch. Voice feminization is a long transition journey for physical, neurophysiological, and psychosomatic changes that convert a male phonatory system to a female phonatory system. Therefore, strategies for voice feminization should be individualized according to the individual’s physical condition, the desired change in voice pitch, economic conditions, and social roles.

Sexual Dimorphism in Laryngeal Volumetric Measurements Using Magnetic Resonance Imaging

The objective of this study is to investigate the dimensional and volumetric measurements in the thyroarytenoid (TA) muscle in men and women using magnetic resonance imaging (MRI). The hypothesis is that there is a gender-related difference in these measurements. A retrospective chart review of 76 patients who underwent MRI of the neck at the American University of Beirut Medical Center was conducted. The dimension and volume of the right and left TA muscle were measured on axial and coronal planes short tau inversion recovery images. Male and female groups were compared with respect to demographic data and MRI findings using parametric and nonparametric tests. The mean length of the thyro-arytenoid muscle in males was larger than that in females on the right (males 2.44 [0.29] cm vs females 1.70 [0.22] cm) and on the left (males 2.50 [0.28] cm vs females 1.72 [0.24] cm) reaching statistical significance (P < .001). The mean width of the thyro-arytenoid muscle in males was larger than that in females on the right (males 0.68 [0.13] cm vs females 0.59 [0.11] cm) and on the left (males 0.68 [0.12] cm vs females 0.57 [0.12] cm) reaching statistical significance (P < .001). The mean height of the thyro-arytenoid muscle in males was larger than that in females on the right (males 1.05 [0.21] cm vs females 0.95 [0.12] cm) and on the left (males 1.05 [0.21] cm vs females 0.95 [0.12] cm) reaching statistical significance (P < .01 on the right and P < .05 on the left). The volume of the thyroarytenoid muscle in males was larger than that in females on the right (males 0.86 [0.25] mL vs females 0.48 [0.15] mL) and on the left (males 0.89 [0.27] mL vs females 0.48 [0.17] mL) reaching statistical significance (P < .001). The results of this investigation clearly indicate a significant difference in these measurements between men and women.

A Tutorial of the Effects of Sex Hormones on Laryngeal Senescence and Neuromuscular Response to Exercise

Purpose The purpose of this tutorial is to summarize how sex hormones affect both laryngeal senescence and neuromuscular response to exercise, highlighting the importance of considering sex differences in developing treatment for the senescent voice. Conclusion Men and women's voices are sexually dimorphic throughout the life span, including during the laryngeal adaptations observed during senescence. Therefore, presbyphonia (age-related dysphonia) likely clinically manifests differently for men and women due to differences in how the male and the female larynx change in response to aging. Because sexual dimorphism is evident in both laryngeal aging and response to exercise, voice therapy programs aimed at treating the typical and disordered aged voice should consider sex differences in their design.

Vocal Dose in Older Adults with Presbyphonia: An Analytic, Cross-Sectional Study

PURPOSE

Older patients with age-related voice changes (presbyphonia) are considered vocal under-doers due to a reportedly low a amount and intensity of voice use (ie, low vocal dose). This low voice use may be consequential to negative effects of presbyphonia like throat discomfort, as well as anxiety and frustration from difficulty communicating. Causally speaking, vocal fold atrophy (presbylaryngis) may indicate inadequate intrinsic laryngeal muscle loading with low voice use, though research is lacking. As a first step, this study examined voice use objectively using vocal dosimetry in older adults with presbyphonia. We hypothesized participants, especially if retired, would exhibit low vocal doses, and lower than reported for other populations.

METHOD

This research used an analytic, cross-sectional design with subgroup analyses to determine feasibility of vocal dosimetry in older adults with presbyphonia. Thirteen older adults with presbyphonia (7 males) completed vocal dose monitoring using an ambulatory phonation monitor (APM). The APM measured vocal parameters over a day of monitoring, from which time, cycle, and distance doses were calculated. Data also were gathered on demographics, vocal handicap, and vocal effort.

RESULTS

Descriptively, the group showed a low mean time dose as compared to published vocal dose data from other populations. Females exhibited significantly higher mean values of time dose, cycle dose, and fundamental frequency than males. Time dose for males was negatively correlated with vocal effort. Subgroup analyses failed to detect an effect of age group, but found significantly a higher mean value for time dose in employed, compared to retired, participants.

CONCLUSIONS

Consistent with self-report, we found older adults with presbyphonia exhibit low time doses, which were in contrast to high vocal doses published on teachers, patients with dysphonia, and even office workers. We found differences in vocal dose as a function of sex and employment status. Though a limited sample, findings suggest patients with presbyphonia may demonstrate low vocal dose, which may be a useful target in treatment.

Volumetric analysis of vocal fold atrophy via magnetic resonance imaging

Objective

To quantitatively test the hypothesis that older patients have increased thyroarytenoid muscle atrophy by comparing thyroarytenoid muscle volumes across different age groups.

Methods

A retrospective chart review was conducted. The study included 111 patients with no history of laryngeal pathology. Two investigators reviewed magnetic resonance imaging studies of these patients and manually traced the thyroarytenoid muscles on multiple slices bilaterally. Thyroarytenoid muscle volumes were then computed using imaging analysis software. Patients were stratified into three age groups (18–50 years, 51–64 years, and 65 years or older) for comparison.

Results

Intra- and inter-rater reliabilities were excellent for all measurements (intraclass correlation co-efficient > 0.90). There was no statistically significant difference in the mean volumes of left and right thyroarytenoid muscles in all age and gender groups.

Conclusion

Given the lack of statistically significant difference in thyroarytenoid muscle volume between age groups on magnetic resonance imaging, the prevailing assumption that age-related thyroarytenoid muscle atrophy contributes to presbyphonia should be re-examined.

Indicators of Dysphagia in Aged Care Facilities

PURPOSE

The current cross-sectional study aimed to investigate risk factors for dysphagia in elderly individuals in aged care facilities.

METHOD

A total of 878 individuals from 42 aged care facilities were recruited for this study. The dependent outcome was speech therapist-determined swallowing function. Independent factors were Eating Assessment Tool score, oral motor assessment score, Mini-Mental State Examination, medical history, and various functional status ratings. Binomial logistic regression was used to identify independent variables associated with dysphagia in this cohort.

RESULTS

Two statistical models were constructed. Model 1 used variables from case files without the need for hands-on assessment, and Model 2 used variables that could be obtained from hands-on assessment. Variables positively associated with dysphagia identified in Model 1 were male gender, total dependence for activities of daily living, need for feeding assistance, mobility, requiring assistance walking or using a wheelchair, and history of pneumonia. Variables positively associated with dysphagia identified in Model 2 were Mini-Mental State Examination score, edentulousness, and oral motor assessments score.

CONCLUSIONS

Cognitive function, dentition, and oral motor function are significant indicators associated with the presence of swallowing in the elderly. When assessing the frail elderly, case file information can help clinicians identify frail elderly individuals who may be suffering from dysphagia.

Sexual dimorphism in laryngeal muscle fibers and ultrasonic vocalizations in the adult rat

OBJECTIVE

The human voice is sexually dimorphic in obvious ways, such as differences in fundamental frequency and gross laryngeal anatomy, but also in less apparent ways, such as in the prevalence and types of voice disorders and the manifestation of voice changes in advanced age. Differences between males and females are rarely explored, however, in mechanistic animal studies. The goal of this study was to explore sexual dimorphism in laryngeal function and structure in adult rats by examining ultrasonic vocalization acoustics and muscle fiber size and type in the thyroarytenoid muscle.

STUDY DESIGN

Animal group comparison.

METHODS

Spontaneous ultrasonic vocalizations from 10 male adult rats and 10 female adult rats were recorded, classified, and acoustically analyzed. Cross-sections of the thyroarytenoid muscle were stained and imaged for analysis of muscle fiber size and type. Acoustic and muscle parameters were statistically compared between sexes.

RESULTS

Male rats had a lower mean frequency of short ultrasonic vocalizations. Male rats also had a larger mean fiber size in the external division of the thyroarytenoid and larger overall muscle area in both the vocalis and external divisions of the thyroarytenoid. However, muscle fiber type compositions were similar between sexes in both the vocalis and external division of the thyroarytenoid muscles.

CONCLUSION

Functional and structural laryngeal differences exist between adult male and female rats; therefore, the rat model can be used to further study sexual dimorphism of the voice.

LEVEL OF EVIDENCE

NA. Laryngoscope, 127:E270-E276, 2017.

Basic Science: The Foundation of Evidence-Based Voice Therapy

Basic science research is part of the circle of translational research that provides the scientific underpinning for evidence-based practice. The translation from bench to bedside, however, is sometimes not obvious. This short review seeks to demonstrate ways in which basic science can inform our clinical practice as voice therapists. From in vitro molecular and cellular studies to in vivo animal models, basic science can investigate biological mechanisms of vocal health, such as vocal fold hydration, and voice use, such as voice rest and vocal exercise, in ways that are impossible in human clinical studies. Knowledge of these mechanisms inform and guide our clinical investigations and help provide evidence for behavioral voice therapy.

The effects of treadmill running on aging laryngeal muscle structure

OBJECTIVES/HYPOTHESIS

Age-related changes in laryngeal muscle structure and function may contribute to deficits in voice and swallowing observed in elderly people. We hypothesized that treadmill running, an exercise that increases respiratory drive to upper airway muscles, would induce changes in thyroarytenoid muscle myosin heavy chain (MHC) isoforms that are consistent with a fast-to-slow transformation in muscle fiber type.

STUDY DESIGN

Randomized parallel group controlled trial.

METHODS

Fifteen young adult and 14 old Fischer 344/Brown Norway rats received either treadmill running or no exercise (5 days/week/8 weeks). Myosin heavy chain isoform composition in the thyroarytenoid muscle was examined at the end of 8 weeks.

RESULTS

Significant age and treatment effects were found. The young adult group had the greatest proportion of superfast-contracting MHCIIL isoform. The treadmill running group had the lowest proportion of MHCIIL and the greatest proportion of MHCIIx isoforms.

CONCLUSION

Thyroarytenoid muscle structure was affected both by age and treadmill running in a fast-to-slow transition that is characteristic of exercise manipulations in other skeletal muscles.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:672-677, 2016.

Changes in Rat 50-kHz Ultrasonic Vocalizations During Dopamine Denervation and Aging: Relevance to Neurodegeneration

Vocal communication is negatively affected by neurodegenerative diseases, such as Parkinson disease, and by aging. The neurological and sensorimotor mechanisms underlying voice deficits in Parkinson disease and aging are not well-understood. Rat ultrasonic vocalizations provide a unique behavioral model for studying communication deficits and the mechanisms underlying these deficits in these conditions. The purpose of this review was to examine the existing literature for methods using rat ultrasonic vocalization with regard to the primary disease pathology of Parkinson disease, dopamine denervation, and aging. Although only a small amount of papers were found for each of these topics, results suggest that both shared and unique acoustic deficits in ultrasonic vocalizations exist across conditions and that these acoustic deficits are due to changes in either dopamine signaling or denervation and in aging models changes to the nucleus ambiguus, at the level of the neuromuscular junction, and the composition of the vocal folds in the larynx. We conclude that ultrasonic vocalizations are a useful tool for studying biologic mechanisms underlying vocal communication deficits in neurodegenerative diseases and aging.

Electrical stimulation in treatment of pharyngolaryngeal dysfunctions

OBJECTIVE

Neuromuscular electrical stimulation (NMES) has been proposed in the treatment of laryngopharyngeal dysfunctions (dysphonia, dyspnoea, dysphagia) for more than 40 years. Several studies have investigated possible therapeutic effects. Some researchers described favourable results, whereas others did not find relevant benefits. This article aims to review available studies to give an overview regarding the current state of knowledge.

METHODS

We conducted a selective literature search using PubMed.

RESULTS

In total, 356 papers were identified: 6 case reports, 11 reviews, 43 prospective clinical trials and 3 retrospective trials were found.

CONCLUSION

Due to different stimulation protocols, electrode positioning and various underlying pathological conditions, summarizing the present studies appears to be difficult. However, there is evidence that NMES is a valuable adjunct in patients with dysphagia and in patients with vocal fold paresis. Nevertheless, more empirical data is needed to fully understand the benefits provided by NMES. Further research suggestions are put forward.

Psychosocial risk factors which may differentiate between women with Functional Voice Disorder, Organic Voice Disorder and a Control group

This study aimed to explore psychosocial factors contributing to the development of functional voice disorders (FVD) and those differentiating between organic voice disorders (OVD) and a non-voice-disordered control group. A case-control study was undertaken of 194 women aged 18-80 years diagnosed with FVD (n = 73), OVD (n = 55), and controls (n = 66). FVD women were allocated into psychogenic voice disorder (PVD) (n = 37) and muscle tension voice disorder (MTVD) (n = 36) for sub-group analysis. Dependent variables included biographical and voice assessment data, the number and severity of life events and difficulties and conflict over speaking out (COSO) situations derived from the Life Events and Difficulties Schedule (LEDS), and psychological traits including emotional expressiveness scales. Four psychosocial components differentiated between the FVD and control group accounting for 84.9% of the variance: severe events, moderate events, severe COSO, and mild COSO difficulties. Severe events, severe and mild COSO difficulties differentiated between FVD and OVD groups, accounting for 80.5% of the variance. Moderate events differentiated between PVD and MTVD sub-groups, accounting for 58.9% of the variance. Psychological traits did not differentiate between groups. Stressful life events and COSO situations best differentiated FVD from OVD and control groups. More refined aetiological studies are needed to differentiate between PVD and MTVD.

Vocal training mitigates age-related changes within the vocal mechanism in old rats

Aging affects voice production and is associated with reduced communicative ability and quality of life. Voice therapy is a critical component of treatment, but its effects on neuromuscular mechanisms are unknown. The ultrasonic vocalizations (USVs) of rats can be used to test the effects of aging and voice use on the laryngeal neuromuscular system. This study tested the hypothesis that age-related changes in the USVs of rats and laryngeal neuromuscular junctions can be reversed through vocal exercise. Young and old rats were trained for 8 weeks to increase their USVs and were compared with a no intervention group pre- and post-treatment. USV acoustics and aspects of neuromuscular junction (NMJ) morphology were measured in the thyroarytenoid muscle. Vocal training reduced or eliminated some age differences found in both USVs and NMJs. We conclude that vocal exercise may assist in mitigating age-related changes in voice characteristics and underlying neuromuscular adaptations.

Effects of aging on thyroarytenoid muscle regeneration

OBJECTIVES/HYPOTHESIS

Regenerative properties of age-associated changes in the intrinsic laryngeal muscles following injury are unclear. The purpose of this study was to investigate the regenerative properties of the thyroarytenoid (TA) muscle in an aging rat model. The hypothesis was that following myotoxic injury, old animals would exhibit a decrease in mitotic activities of muscle satellite cells when compared with younger rats, suggesting reduced regenerative potential in the aging rat TA muscle.

STUDY DESIGN

Animal group comparison.

METHODS

Regeneration responses following injury to the TA muscle were examined in 18 young adult, middle-aged, and old Fischer 344/Brown Norway rats. TA muscle fiber cross-sectional area (CSA), satellite cell mitosis (number/fiber), and regeneration index (CSA injured side/CSA noninjured side) were measured and compared across age groups.

RESULTS

Young adult animals had a significantly higher regeneration index than the middle-aged and old groups. Within the lateral region of the TA muscle (LTA), the regeneration index was significantly higher in the young adult animals than in the middle-aged and old animals. The regeneration index of the medial TA was significantly higher than the LTA across all age groups.

CONCLUSIONS

The regenerative capacity of the TA muscle is impaired with increasing age.

Effect of aging on ultrasonic vocalizations and laryngeal sensorimotor neurons in rats

While decline in vocal quality is prevalent in an aging population, the underlying neurobiological mechanisms contributing to age-related dysphonia are unknown and difficult to study in humans. Development of an animal model appears critical for investigating this issue. Using an established aging rat model, we evaluated if 50-kHz ultrasonic vocalizations in 10, 32-month-old (old) Fischer 344/Brown Norway rats differed from those in 10, 9-month-old (young adult) rats. The retrograde tracer, Cholera Toxin β, was injected to the thyroarytenoid muscle to determine if motoneuron loss in the nucleus ambiguus was associated with age. Results indicated that older rats had vocalizations with diminished acoustic complexity as demonstrated by reduced bandwidth, intensity, and peak frequency, and these changes were dependent on the type of 50-kHz vocalization. Simple calls of old rats had reduced bandwidth, peak frequency, and intensity while frequency-modulated calls of old rats had reduced bandwidth and intensity. Surprisingly, one call type, step calls, had increased duration in the aged rats. These findings reflect phonatory changes observed in older humans. We also found significant motoneuron loss in the nucleus ambiguus of aged rats, which suggests that motoneuron loss may be a contributing factor to decreased complexity and quality of ultrasonic vocalizations. These findings suggest that a rat ultrasonic phonation model may be useful for studying age-related changes in vocalization observed in humans.

Molecular genetic studies of gene identification for sarcopenia

Sarcopenia, which is characterized by a progressive decrease of skeletal muscle mass and function with aging, is closely related to several common diseases (such as cardiovascular and airway diseases) and functional impairment/disability. Strong genetic determination has been reported for muscle mass and muscle strength, two most commonly recognized and studied risk phenotypes for sarcopenia, with heritability ranging from 30 to 85% for muscle strength and 45-90% for muscle mass. Sarcopenia has been the subject of increasing genetic research over the past decade. This review is designed to comprehensively summarize the most important and representative molecular genetic studies designed to identify genetic factors associated with sarcopenia. We have methodically reviewed whole-genome linkage studies in humans, quantitative trait loci mapping in animal models, candidate gene association studies, newly reported genome-wide association studies, DNA microarrays and microRNA studies of sarcopenia or related skeletal muscle phenotypes. The major results of each study are tabulated for easy comparison and reference. The findings of representative studies are discussed with respect to their influence on our present understanding of the genetics of sarcopenia. This is a comprehensive review of molecular genetic studies of gene identification for sarcopenia, and an overarching theme for this review is that the currently accumulating results are tentative and occasionally inconsistent and should be interpreted with caution pending further investigation. Consequently, this overview should enhance recognition of the need to validate/replicate the genetic variants underlying sarcopenia in large human cohorts and animal. We believe that further progress in understanding the genetic etiology of sarcopenia will provide valuable insights into important fundamental biological mechanisms underlying muscle physiology that will ultimately lead to improved ability to recognize individuals at risk for developing sarcopenia and our ability to treat this debilitating condition.

Chronic stimulation-induced changes in the rodent thyroarytenoid muscle

PURPOSE

Therapies for certain voice disorders purport principles of skeletal muscle rehabilitation to increase muscle mass, strength, and endurance. However, applicability of limb muscle rehabilitation to the laryngeal muscles has not been tested. In this study, the authors examined the feasibility of the rat thyroarytenoid muscle to remodel as a consequence of increased activity instantiated through chronic electrical stimulation.

METHOD

Twenty adult Sprague-Dawley rats (Rattus norvegicus), assigned to a 1-week or 2-week stimulation group, were implanted with a nerve cuff electrode placed around the right recurrent laryngeal nerve and were fitted with a head connector. All animals were placed under anesthesia twice a day for 1 hr each time. Following the training, rats were killed, and thyroarytenoid muscles were isolated for histology and immunohistochemistry.

RESULTS

Mean muscle fiber area decreased, neuromuscular junction density increased, mitochondrial content increased qualitatively, and glycogen-positive fibers increased, demonstrating exercise-induced changes similar to those seen in limb muscles after endurance training.

CONCLUSION

Rat thyroarytenoid muscles are capable of remodeling in response to chronic electrical stimulation.

Medidas da dinâmica respiratória em idosos participantes de grupos de terceira idade

OBJETIVO: analisar medidas da dinâmica respiratória em participantes de grupos de terceira idade. MÉTODO: participaram 41 pessoas, 32 do sexo feminino e nove do masculino, idade média de 69,90 anos. A avaliação foi realizada por meio das medidas de tempos máximos de fonação (TMF) das vogais /a/, /i/, /u/, das consoantes /s/ e /z/ e contagem de números; relação s/z; medida de capacidade vital (CV) e cocientes fônicos simples (CFS) e composto (CFC). RESULTADOS: os valores médios dos indivíduos do sexo masculino para os TMF das vogais, consoantes e contagem de números foram respectivamente, 18,11s; 19,22s; 19,11s; 15,22s e 15,61s e 18,77s, sendo 0,98 o valor da relação s/z. No sexo feminino, as médias das mesmas medidas de TMF foram respectivamente 13,94s; 14,19s; 13,98s; 10,11s e 11,63s; 13,90s, sendo 0,92 a relação s/z. A média de TMF das vogais foi significativamente maior que a média das consoantes no grupo feminino. O valor médio da CV sem oclusão nasal no sexo feminino foi de 2.247ml e no masculino de 3.211 ml. Foi verificada relação significante entre a medida de CV e a variável idade, no grupo feminino. Os valores médios do CFS nos grupos de homens e mulheres foram respectivamente 182,11 ml/s e 176,58 ml/s e do CFC, 184,35 ml/s e 186,93 ml/s. CONCLUSÃO: as medidas da dinâmica respiratória dos participantes estiveram próximas aos valores de referência para adultos na literatura, bem como próximos aos de estudos de idosos, havendo diferenças para mais ou para menos nas diferentes medidas estudadas.

Correlação entre o envelhecimento e as dimensões das pregas vocais

OBJETIVO: avaliar as dimensões das pregas vocais em ambos os sexos e correlacioná-las com o envelhecimento. MÉTODO: foram estudados 30 cadáveres (15 mulheres e 15 homens) na faixa etária de 60 a 102 anos. Para isto foram seguidas quatro etapas sequenciais: 1ª) História clínica do cadáver; 2ª) Remoção da laringe; 3ª) Dissecação da laringe; 4ª) Morfometria das dimensões das pregas vocais. Trata-se de um estudo experimental. RESULTADOS: o comprimento da prega vocal masculina com média de 15,90 mm foi maior que o da feminina com 10,39 mm. A largura da prega vocal masculina foi maior com média de 2,37 mm que a feminina com 2,31 mm. A média geral da espessura também foi maior no sexo masculino com média de 2,55 mm em comparação com a feminina com 2,38 mm. Não foram encontradas diferenças estatísticas entre a idade e o comprimento, largura e espessura das pregas vocais em ambos os sexos. CONCLUSÃO: as dimensões de comprimento, largura e espessura das pregas vocais foram maiores no sexo masculino. Entretanto, não houve diferença, estatisticamente significante, entre as três dimensões das pregas vocais durante o envelhecimento em ambos os sexos.

Treatment success for age-related vocal fold atrophy

OBJECTIVES/HYPOTHESIS

To characterize perceived voice handicap of patients diagnosed with vocal fold atrophy and review treatment success.

STUDY DESIGN

Retrospective study.

METHODS

Two hundred seventy-five patients diagnosed with vocal fold atrophy (January 2007-January 2009) were reviewed from a preexisting clinical database. Outcome measures included pre/post-treatment Voice Handicap Index-10 and data from a voice therapy discharge survey.

RESULTS

Five groups emerged from the data set. Group A: patients who had no follow-up (69%). After removing group A from the data set, the following groups emerged: group B: patients who had no treatment but some follow-up (31%); group C: patients who had voice therapy only (44%); group D: patients who had surgery only (15%); and group E: patients who had voice therapy first and subsequent surgery (9%). The perceived voice handicap severity was worse for groups C and D compared to groups A, B, and E. Treatment success outcomes showed that groups C (36%), D (56%), and E (17%) only improved marginally. However, 81% of patients diagnosed with atrophy believed that voice therapy helped them but only by 48%.

CONCLUSIONS

Treatment success for age-related vocal fold atrophy is poor to moderately poor for this cohort of patients.

Effect of dystrophin deficiency on selected intrinsic laryngeal muscles of the mdx mouse

BACKGROUND

Intrinsic laryngeal muscles (ILM) show biological differences from the broader class of skeletal muscles. Yet most research regarding ILM specialization has been completed on a few muscles, most notably the thyroarytenoid and posterior cricoarytenoid. Little information exists regarding the biology of other ILM. Early evidence suggests that the interarytenoid (IA) and cricothyroid (CT) may be more similar to classic skeletal muscle than their associated laryngeal muscles. Knowledge of the IA and CT's similarity or dissimilarity to typical skeletal muscle may hold implications for the treatment of dysphonia.

PURPOSE

The purpose of this study was to further define IA and CT biology by examining their response to the biological challenge of dystrophin deficiency.

METHOD

Control and dystrophin-deficient superior cricoarytenoid (SCA; mouse counterpart of IA) and CT muscles were examined for fiber morphology, sarcolemmal integrity, and immunohistochemical detection of dystrophin.

RESULTS

Despite the absence of dystrophin, experimental muscles did not show disease markers.

CONCLUSIONS

The SCA and the CT appear spared in dystrophin-deficient mouse models. These laryngeal muscles possess specializations that separate them from typical skeletal muscle. Considered in light of previous research, the CT and IA may represent transitional form of muscle, evidencing properties of typical and specialized skeletal muscle.

Descrição da qualidade vocal de personagens idosos dos filmes de Hollywood

OBJETIVO: descrever a qualidade vocal de personagens idosos dos filmes de Hollywood. MÉTODOS: foram colhidas 50 amostras de fala de personagens idosos, 11 do sexo feminino e 39 do masculino, de 38 filmes hollywoodianos dos anos de 1993 a 2001. Através da análise perceptivo-auditiva das amostras de fala, 20 fonoaudiólogos treinados classificaram cada personagem em idoso e não idoso, além de avaliarem as vozes quanto aos seguintes parâmetros citados pela literatura como mais alterados: rouquidão, crepitação, soprosidade, tensão, aspereza, astenia, nasalidade, tremor, modulação, pitch e estabilidade da frequência fundamental. RESULTADOS: após a análise perceptivo-auditiva, foi observado que a grande maioria dos atores (82%) utilizou voz de idoso para representar seus papéis. O marcador mais evidente nas vozes foi alteração na qualidade vocal (92%), demonstrada por crepitação (80%), soprosidade (54%), tensão (38%), rouquidão (30%) e astenia (28%). O segundo marcador mais utilizado pelos atores nas suas representações foi a modulação vocal ampla e variada (44%). Também foram observadas alterações no controle da voz (36%) e instabilidade da frequência fundamental (38%). CONCLUSÃO: a partir dos resultados obtidos pode-se concluir que os filmes de Hollywood caracterizam o idoso através de desvios evidentes na qualidade e modulação da voz, utilizando tipos de vozes alteradas e modulação vocal ampla e instável.

Percepção da voz e saúde vocal em idosos coralistas

OBJETIVO: analisar a percepção da voz e de suas alterações e os cuidados de saúde vocal de idosos coralistas. MÉTODOS: são sujeitos 10 idosos (seis mulheres e quatro homens) do Coral Evangélico de Piracicaba (SP). Foi aplicado o questionário Qualidade de vida e voz (QVV), realizada entrevista aberta sobre o que acham da voz, queixas e cuidados e a avaliação vocal. Procedimentos de análise: análise de Conteúdo/análise temática, análise descritiva das questões, cálculo do escore global do QVV e análise perceptivo-auditiva fonoaudiológica por meio da escala GRBASI e avaliação dos parâmetros vocais. RESULTADOS: nove idosos avaliaram a voz como boa e apresentaram imagem vocal positiva, com escore médio de 96,5 pontos no QVV. Apesar disto, manifestaram dificuldades relacionadas com a respiração, articulação, modulação, além de alterações vocais em grau leve (rugosidade e soprosidade) na avaliação fonoaudiológica. Os cuidados com a voz se mostraram insuficientes para a promoção da saúde vocal. CONCLUSÃO: o grupo de idosos coralistas pesquisado, apesar de não ter queixas e estar satisfeito com a voz, apresenta dificuldades relacionadas aos cuidados de saúde vocal, à percepção da voz e do processo saúde-doença vocal bem como parâmetros alterados.