Nationwide Survey on the Characteristics and Treatment of Age-Related Vocal Fold Atrophy in Japan

As the global population ages, age-related vocal fold atrophy (ARVA) is increasingly recognized. However, no nationwide epidemiological studies have been conducted. We aimed to investigate the clinical characteristics and treatments of ARVA in Japan, the world's most aged society.

This multicenter retrospective study, part of the Tokyo Voice Center Initiative, analyzed medical records of 1365 patients diagnosed with ARVA between 2018 and 2022. The primary survey examined the involvement of speech language pathologist (SLP) and the routine use of stroboscopic examinations at 34 certified institutions. The secondary survey assessed hoarseness severity (via maximum phonation time and voice handicap index-10), age of onset, treatment methods, and treatment outcomes at 14 certified institutions.

All diagnoses and assessments were conducted by departments of otolaryngology-head and neck surgery. Of the 1365 patients (637 females, 728 males; mean age: 64.6 ± 14.7 years), 1097 received treatment and 268 did not. Treatments included voice therapy (n = 1031), injection augmentation (n = 162), and surgery (n = 18), with some receiving multiple therapies. Voice therapy was more effective when provided by voice-specialized SLPs. Invasive treatments yielded greater voice improvement overall. Significant differences in age and sex ratios were found between institutions (P < 0.01).

These findings underscore the need for cross-specialty education, broader awareness of ARVA, and establishment of a national database and severity classification system.