Vocal Fold Atrophy: Where Are We and Where Do We Need to Go? A Systematic Review and Meta-analysis

To identify and compare efficacy of treatments for presbyphonia.

PubMed, Ovid MEDLINE, and Embase.

Three databases were searched for articles from 2013 to 2023 according to PRISMA guidelines. Additional studies were identified from citation review. Data was reviewed for demographics, preoperative data, intervention technique, and outcome measures. Study interventions were categorized into two final groups: voice therapy and augmentation. For outcome measures reported in both interventions, a random effects model was performed to assess mean difference.

An initial search yielded 169 articles, with 24 publications meeting criteria for inclusion (n = 432; augmentation, A = 101, fibroblast growth factor injection, FGF = 116, voice therapy, VT = 215). The mean age of included subjects was 71.2 years. Outcome measures reported across both intervention categories were VHI-10 and the maximum phonation time (MPT). Overall mean difference for all interventions was -1.20 (95% CI: -1.65, -0.75; P < 0.001) on VHI-10 and +1.53 (95% CI: -0.23, 3.30; P = 0.09) on MPT. Voice therapy demonstrated a higher mean effect size for both outcomes (VHI-10: A -1.15 vs VT -1.26; MPT: A +0.73 vs VT +1.95), though differences between treatment groups did not reach statistical significance for either measure (VHI-10 P = 0.80; MPT P = 0.38).

Voice therapy demonstrated a numerically higher effect size across both VHI-10 and MPT outcomes but did not demonstrate statistical superiority over augmentation. Other objective measures were not consistently reported. In practice, clinicians employ combinations of voice therapy, injection augmentation, and laryngeal framework surgery in varying order. Prospective studies are needed to determine which treatment algorithms best serve patients with presbyphonia.