Extreme presbyphonia

Specialty: Geriatrics.

• weakened senile voice
• vocal fold atrophy due to age
• senile phonatory weakness
• hypophonia of the elderly

Why it occurs

• Physiological atrophy of the muscle fibers of the vocal cords (thyroarytenoid muscle) and loss of elasticity of the vocal ligament associated with aging
• Decrease in lung vital capacity and diaphragmatic respiratory support
• Chronic xerostomia that drastically reduces laryngoglottic lubrication
• Undiagnosed clinical or subclinical hypothyroidism associated with submucosal edema of the vocal cords
• Incipient parkinsonism with characteristic hypophonia secondary to rigidity of the phonatory muscles and loss of voice intensity control

Initial workup

Flexible fibrolaryngoscopy by Otorhinolaryngology (to evaluate glottic closure, rule out neoplastic lesions, polyps or vocal cord paralysis); spirometry with flow-volume curve; blood analysis with determination of thyroid hormones (TSH, free T4); evaluation of swallowing and pharyngeal clearance through specialized speech therapy assessment.

Standard management

• Systematic oral hydration — intake of at least 1.5 liters of water per day if there is no medical contraindication
• Tears or artificial saliva spray if severe xerostomia coexists due to senile Sjögren's syndrome or effects of radiotherapy
• Avoid the use of unnecessary loop diuretics or excessive doses that dehydrate the mucous membranes of the upper airway.
• Optimized treatment of gastroesophageal reflux with PPI (for example, pantoprazole 20 mg orally daily) if reflux laryngitis worsening presbyphonia is evident.