Comparative Evaluation and Management of Dysphonia Between Adults <65 and ≥65 Years of Age.

OBJECTIVE: To compare presenting symptoms, etiology, and treatment outcomes among dysphonic adults <65 and ≥65 years of age. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary care voice center between January 2011 and June 2016. METHODS: A total of 755 patients presenting for dysphonia were included in the study: 513 adults <65 years of age and 242 adults ≥65. Data collected included demographics, referral information, prior diagnoses, prior treatments, clinical examination findings, diagnosis, coexisting symptoms, treatments, and pre- and postintervention Voice Handicap Index scores. Statistical analysis was performed with SPSS to determine significant relationships between variables of interest. RESULTS: The most common etiologies of dysphonia were vocal cord atrophy (44.8%) in the ≥65 cohort and benign vocal cord lesions (17.8%) in the <65 cohort. When compared with adults <65 years old, patients ≥65 had a higher incidence of neurologic dysphonia (P = .006) and vocal cord atrophy (P < .001) but were less likely to have laryngopharyngeal reflux (P = .001), benign vocal cord lesions (P < .001), or muscle tension dysphonia (P < .001). Overall, 139 patients had surgery, 251 received medical therapy, and 156 underwent voice therapy. The ≥65 cohort demonstrated improvement in Voice Handicap Index scores after surgery (P = .001) and voice therapy (P = .034), as did the <65 cohort (surgery, P < .001; voice therapy, P = .015). Adult surgical patients <65 reported greater improvements than patients ≥65 (P = .021). CONCLUSIONS: There are notable differences in the pathophysiology of dysphonia between patients aged ≥65 and <65 years. Although adults <65 reported slightly better outcomes with surgery, patients ≥65 obtained significant benefit from surgery and voice therapy.