Perceived disability from hearing and voice changes in the elderly

Prevalence of Voice Disorders in Older Adults: A Systematic Review and Meta-Analysis

PURPOSE

Voice disorders significantly impair the ability to communicate effectively and reduce the quality of life in older adults; however, its prevalence has not been well established. The aim of our research was to investigate the prevalence and associated factors of voice disorders among the older population.

METHOD

Five medical databases were systematically searched for studies that reported the prevalence of voice disorders in older adults. The overall prevalence was exhibited in proportions and 95% confidence intervals (CIs) utilizing random-effects models. Heterogeneity was measured using I ² statistics.

RESULTS

Of 930 articles screened, 13 fulfilled the eligibility criteria, including 10 studies in community-based settings and three in institutionalized settings. An overall prevalence of voice disorders in older adults was estimated to be 18.79% (95% CI [16.34, 21.37], I ² = 96%). Subgroup analysis showed a prevalence of 33.03% (95% CI [26.85, 39.51], I ² = 35%) in institutionalized older adults, which was significantly higher than that in the community-based older adults with 15.2% (95% CI [12.65, 17.92], I ² = 92%). Some factors that influenced the reported prevalence were identified, including types of survey, the definition of voice disorders, sampling methods, and the mean age of the population among included studies.

CONCLUSIONS

The prevalence of voice disorders in the older population depends on various factors but is relatively common in older adults. The findings of this study accentuate the necessity for researchers to standardize the protocol for reporting geriatric dysphonia as well as for older adults to express their voice-related problems so that they will receive appropriate diagnosis and treatment.

Presbylarynx: Is it Possible to Predict Glottal Gap by Cut-Off Points in Auto-Assessment Questionnaires?

PURPOSE

To determine cut-off points in auto-assessment questionnaires to predict the presence and extent of presbylarynx signs.

METHOD

This case control, prospective, observational, and cross-sectional study was carried out on consecutive subjects observed by Otorhinolaryngology, in a tertiary center, in 2020. Each subject underwent fiberoptic videolaryngoscopy with stroboscopy, and presbylarynx was considered when it was identified two or more of the following endoscopic findings: vocal fold bowing, prominence of vocal processes in abduction, and a spindle-shaped glottal gap. Each subject completed three questionnaires: the Voice Handicap Index (VHI), with 30 and 10 questions, and the "Screening for voice disorders in older adults questionnaire" (RAVI).

RESULTS

The studied population included 174 Caucasian subjects (60 males; 114 females), with a mean age of 73.99 years (standard deviation = 6.37; range 65-95 years). Presbylarynx was identified in 71 patients (41%). Among patients with presbylarynx, a glottal gap was identified in 22 patients (31%). The mean score of VHI-30 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. The presence of glottal gap was associated to a higher mean score of VHI-30 (41.64 ± 11.87) (P < 0.001). The mean score of VHI-10 between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to higher mean score of VHI-10 (14.04 ± 3.91) (P < 0.001). There was a strong positive correlation between VHI-30 and VHI-10 (rs = 0.969; P < 0.001). The mean score of RAVI between "no presbylarynx" and "presbylarynx" groups was statistically different (P < 0.001), with a higher score for subjects with signs of presbylarynx. Among patients with presbylarynx, the presence of glottal gap was associated to a higher mean score of RAVI (11.68 ± 1.61) (P < 0.001). There was a strong positive correlation not only between RAVI and VHI-30 (rs = 0.922; P < 0.001), but also between RAVI and VHI-10 (rs = 0.906; P < 0.001). The optimal cut-off points to discriminate "no presbylarynx" from "presbylarynx", obtained by the Youden' index, were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity. The optimal cut-off points to predict glottal gap, obtained by the Youden' index, were 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10.

CONCLUSION

The optimal cut-off points do discriminate "no presbylarynx" from "presbylarynx" were 3.5 for RAVI, 4.5 for VHI-30 and 1.5 for VHI-10. RAVI had the highest sensitivity and specificity, probably because it was designed specifically for vocal complaints of the elderly. Among patients with presbylarynx, cut-off points of 9.5 for RAVI, 21 for VHI-30 and 7.5 for VHI-10 were determined to predict patients with and without glottal gap. It was found a strong positive correlation between RAVI, VHI-30 and VHI-10. Thus, VHI-10 can be preferred to VHI-30 to assess voice impairment in clinical practice, because for elderly patients it is easier to answer. However, to predict endoscopic signs of presbylarynx, RAVI should be preferred.

Coprevalence of Presbycusis and Its Effect on Outcome of Voice Therapy in Patients With Presbyphonia

OBJECTIVE

To identify the coprevalence of presbycusis and presbycusis and analyze the effect of presbycusis on compliance and result of voice therapy in presbycusis patients.

METHODS

This cross-sectional, prospective cohort study initially screened patients aged ≥65 years who visited our hospital from February 2019 to January 2020. Unaided pure tone audiometry was performed in these subjects to determine the presence of presbycusis. Perceptual voice assessment by an examiner was conducted for screening of presbycusis, and its diagnosis was confirmed through the voice handicap index-10 (VHI-10) questionnaire and a laryngoscopic exam. Patients with presbycusis underwent voice therapy and were assessed for their compliance and outcomes of the treatment according to the coexistence of presbycusis.

RESULTS

Among the 221 patients, presbycusis and presbycusis were diagnosed in 125 (56.6%) and 110 (49.8%) patients, respectively. The copresence of these two disorders were identified in 87 (39.4%) patients, and there was a significant correlation between presbycusis and presbycusis. The effects of voice therapy were examined in the consecutive 40 patients who were diagnosed with presbycusis. There were 21 patients without presbycusis and 19 patients with presbycusis. The average pretreatment voice handicap index-10 score was significantly higher in presbycusis patients; there was no significant difference in the incidence of dropout from voice therapy between the groups. The patients without presbycusis showed a significant improvement in the functional communication measurement (FCM) level and maximum phonation time (MPT) compared with those of patients with presbycusis after voice therapy.

CONCLUSIONS

Presbyphonia and presbycusis coexisted in many elderly people. The improvement in the FCM level and MPT after voice therapy was relatively low if patients with presbycusis accompanied by presbycusis. The copresence of presbycusis did not significantly affect compliance with voice therapy in the patients.

How Does Our Voice Change as We Age? A Systematic Review and Meta-Analysis of Acoustic and Perceptual Voice Data From Healthy Adults Over 50 Years of Age

Purpose Approximately 30% of adults over the age of 50 years present with altered vocal function. Our understanding of how these changes manifest acoustically and perceptually is derived from relatively modest-sized studies using a diversity of tools. Voice changes can arise from the onset of disease or disorder, but also age-related physiological changes, which may not reflect pathology as such. Here, we bring together data on acoustic, perceptual, and instrumental assessments (electroglottography), with the aim of gaining a better understanding of the changes occurring across these measurement domains. We consider these changes in the context of different acoustic features, software programs, and perceptual protocols. Method Studies of voice function in healthy older adults over the age of 50 years were sought. Literature was systematically searched with 746 abstracts reviewed. Forty-seven studies were included in the review. A meta-analysis of included studies compared voice acoustic parameters between sex and age. Sixteen acoustic parameters collected from 1,475 participants were analyzed in the meta-analysis. These included some previously unpublished analyses using data provided by authors of included studies. Results Data from the systematic review suggest that older individuals are perceived to present with higher overall scores of dysphonia and roughness, breathiness, strain, and instability. Acoustically, males have significantly higher scores on measures of perturbation, including noise-to-harmonic ratio and absolute jitter. The meta-analysis outcomes suggest that participants aged 80-89 years produce significantly higher fundamental frequency, jitter percent, shimmer percent, and shimmer in decibels compared to participants aged 60-69 years and a significant increase in relative average perturbation, jitter percent, and shimmer in decibels compared to participants aged 70-79 years. Limited data were available comparing acoustic measures using the same acoustic software. Conclusions Variations in fundamental frequency and frequency and amplitude perturbation increase as healthy adults age. It was difficult to draw definitive conclusions based on existing literature due to variability in hardware used, limited descriptions of study cohorts, or missing data from statistical analysis. Supplemental Material https://doi.org/10.23641/asha.11868663.

Gender differences in improvement of older-person-specific quality of life after hearing-aid fitting

BACKGROUND

Age-related hearing loss is the third most common reason for disability in the world and has a significant impact on quality of life (QoL) amongst older adults.

OBJECTIVE

To determine how the QoL assessment in older-person-specific domains differs between older men and women with age-related hearing loss before and after hearing-aid fittings.

METHODS

The present study was carried out with 105 hearing-impaired outpatients (aged ≥ 60 years) before and after hearing-aid fittings at the University Hospital Olomouc, Czech Republic. The instrument used was the World Health Organization Quality of Life-Older Adults module (WHOQOL-Old). It was completed before hearing-aid fittings and after the first check-up hearing-aid adjustment. The Wilcoxon paired test multiple logistic regression was used to evaluate changes in the QoL after hearing-aid fittings. The distributions of men a women into three subgroups, improved, unchanged, and worsened in each domain, were compared using Fisher's exact test.

RESULTS

A significant QoL improvement when fitting a hearing-aid in the area of Sensory abilities was confirmed in both men and women (p < 0.001). In Autonomy, a significant improvement was recorded only amongst men (p = 0.010). In Past, present and future activities and Social participation, a significant improvement was only recorded amongst women (p = 0.029; p = 0.001). Significant differences were revealed between men and women in changes for Sensory Abilities (p = 0.019), Social Participation (p = 0.036) and Intimacy (p = 0.002).

CONCLUSIONS

The findings of this study suggest that there are gender differences in QoL improvement amongst people with age-related hearing loss after hearing-aid fitting.

Effects of ovarian reserve and hormone therapy on hearing in premenopausal and postmenopausal women: A cross-sectional study

OBJECTIVES

To observe the hearing function around menopause, to analyze the effects of ovarian reserve and hormone therapy on hearing, and to study factors related to hearing loss among women around menopause.

STUDY DESIGN

In this cross-sectional study, we evaluated 109 women around menopause aged 45-55 years, including 40 women with ovarian failure, 48 with ovarian non-failure, and 21 receiving hormone therapy. All women underwent an audiologic evaluation, and hormone blood testing was performed. The general condition, reproductive history, medical history, lifestyle, and menopausal symptoms were collected through a questionnaire.

MAIN OUTCOME MEASURE

The auditory threshold and anti-Mullerian hormone level.

RESULTS

Women in the ovarian failure group presented with a decreased hearing level in all frequency bands compared with those in the ovarian non-failure group; the significant differences occurred at 8000 Hz, 10 000 Hz, 12 500 Hz, and 16 000 Hz in the right-ear air conduction. The auditory threshold was lower in the hormone therapy group than in the ovarian failure group, but the difference was statistically significant only in the right-ear air conduction at 10 000 Hz. There were two risk factors for hearing loss: an anti-Mullerian hormone level <0.01 ng/mL (odds ratio [OR] = 2.624) and frequent earphone use (OR = 3.846).

CONCLUSIONS

A decline in ovarian function is associated with hearing loss in women, especially in relation to extended high-frequency air conduction of the right ear. Preserving ovarian function and reducing earphone use are important measures to protect women's hearing. However, the effect of hormone therapy on hearing requires further investigation.

Voice Disorders in Older Adults Living in Nursing Homes: Prevalence and Associated Factors

OBJECTIVES

To estimate the prevalence and the associated factors with voice disorders (VDs) in older adults living in nursing homes.

STUDY DESIGN

Cross-sectional.

METHODS

A sample of 117 Brazilian individuals of both sexes and preserved cognitive function, aged >59 years, living in 10 nursing homes, was studied. VDs were screened using the validated tool "Rastreamento de Alterações Vocais em Idosos" (RAVI-Screening for Voice Disorders in Older Adults). Associated factors included variables related to socioeconomic and demographic profile; nursing home; general health; ear, nose, and throat conditions; lifestyle; functionality; and psychosocial status. Bivariate analysis was performed by Pearson's chi-square or Fisher's exact test. Multivariate analysis was performed by multiple binomial regression. The significance level was 5%.

RESULTS

The prevalence of VDs was 39.3% (95% confidence interval [CI] = 30.4-48.1). There was no significant difference in prevalence according to age and sex. Multivariate analysis revealed that the prevalence of VDs were independently associated with anxiety symptoms (prevalence ratio [PR] = 1.97, 95% CI = 1.17-3.29), smoking (PR = 1.56, CI = 1.02-2.38), general daily inactivity (PR = 1.62, CI = 1.10-2.38), temporomandibular disorder (PR = 1.68, CI = 1.11-2.54), choking (PR = 1.53, CI = 1.06-2.20), and self-reported hearing loss (PR = 1.52, CI = 1.04-2.21).

CONCLUSION

VDs are common among older adults with preserved cognitive function living in nursing homes. The associated factors with VDs in this population can be prevented, diagnosed, controlled, or treated. Screening procedures and early intervention should be considered.

Age-associated expression of erythropoietin and its receptor in rat spiral ganglion neurons and its association with neuronal apoptosis and hearing alterations

The present study aimed to determine the expression of erythropoietin (EPO) and the EPO receptor (EPOR) in spiral ganglion neurons (SGNs) in the inner ear of rats of various ages, and the associated neuronal apoptosis and hearing alterations. A total of 15 healthy rats (n=30 ears), were divided into three groups: i) A nominated infant group at post-natal day (PND) 12–14, ii) an adult group at PND 60 and iii) a 3-year postnatal aged group. Auditory brainstem response (ABR) measurements were performed on all rats. EPO and EPOR expression in the inner ear was detected by immunohistochemistry. In situ terminal deoxynucleotidyl transferase dUTP nick end labeling assays were performed to detect the apoptosis of SGNs. The average hearing thresholds of the ABR (decibels above normal hearing level) were 5.625±4.955 in the infant, 15.000±8.498 in the adult and 23.500±13.134 in the aged groups. Hearing thresholds for aged and adult rats increased significantly compared with infant rats. However, the difference in latencies of peak I was not significant (P>0.05). EPO in SGNs was detected during different developmental periods without significant alterations, but were reduced compared with Corti's organ or the stria vascularis. EPOR expression increased significantly from infant to adult stage, and this increased expression was maintained in the aged group. An age-associated increase in the apoptosis of SGNs was detected in all three groups (P=0.0347). The potential neuroprotective effects of EPO in SGNs may not be revealed during the aging process under natural conditions, and may be associated with spontaneous neuronal apoptosis and consequently, hearing diminution. However, the age-associated increase in EPOR in SGNs may exert a role in neuroprotection when necessary, for example in presbycusis.

Social representation of "hearing loss": cross-cultural exploratory study in India, Iran, Portugal, and the UK

Background

Hearing loss is one of the most common chronic conditions in older adults. In audiology literature, several studies have examined the attitudes and behavior of people with hearing loss; however, not much is known about the manner in which society in general views and perceives hearing loss. This exploratory study was aimed at understanding the social representation of hearing loss (among the general public) in the countries of India, Iran, Portugal, and the UK. We also compared these social representations.

Materials and methods

The study involved a cross-sectional design, and participants were recruited using the snowball sampling method. A total of 404 people from four countries participated in the study. Data were collected using a free-association task where participants were asked to produce up to five words or phrases that came to mind while thinking about hearing loss. In addition, they were also asked to indicate if each word they presented had positive, neutral, or negative associations in their view. Data were analyzed using various qualitative and quantitative methods.

Results

The most frequently occurring categories were: assessment and management; causes of hearing loss; communication difficulties; disability; hearing ability or disability; hearing instruments; negative mental state; the attitudes of others; and sound and acoustics of the environment. Some categories were reported with similar frequency in most countries (eg, causes of hearing loss, communication difficulties, and negative mental state), whereas others differed among countries. Participants in India reported significantly more positive and fewer negative associations when compared to participants from Iran, Portugal, and the UK. However, there was no statistical difference among neutral responses reported among these countries. Also, more differences were noted among these countries than similarities.

Conclusion

These findings provide useful insights into the public perception of hearing loss that may prove useful in public education and counseling.

Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos--RAVI)--Part I: Validity Evidence Based on Test Content and Response Processes

PURPOSE

To identify the validity evidence based on the content and response processes of the Rastreamento de Alterações Vocais em Idosos (RAVI; "Screening for Voice Disorders in Older Adults"), an epidemiologic screening for voice disorders in older adults.

STUDY DESIGN

This is a prospective, nonrandomized, cross-sectional, validation study.

METHODS

Criteria for defining the domains and elaborating the questions were established to confirm the validity evidence based on the content. A multidisciplinary committee of 19 experts evaluated the questions, and the relevance and representation of the domains were analyzed using the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI), respectively. For validity evidence based on the response processes, 40 individuals of both sexes, aged ≥60 years, were stratified by demographic and socioeconomic condition. They responded to the RAVI, made suggestions, and their verbal and nonverbal reactions were observed.

RESULTS

The first version of the RAVI consisted of 20 questions related to sensations and perceptions associated with the voice. Although the CVI value of 0.80 was satisfactory, the CVI-I and the suggestions of the expert committee indicated that the scale needed to be reformulated. Consultation with older adults indicated a need for further adjustment. The preliminary version of the RAVI consisted of 16 questions.

CONCLUSIONS

The two aspects of validity evidence described in the present study were essential for adapting the questions to better fit the construct of the questionnaire. Other aspects of validity evidence and reliability analysis will be described in part II of this study.