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Vocal Fold Opening Position Impacts Bowing Measures in Age-Related Vocal Atrophy
Carson S Miller1,2, Byron S Kim1,2, Mahdi Al-Ghezi1,2
1Division of Laryngology, Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, Washington, USA.
The Laryngoscope
|July 4, 2026
Summary
Age-related vocal atrophy (ARVA) causes vocal fold bowing, quantified by the Bowing Index (BI). This study found BI is higher during abduction than adduction, particularly at semi-abduction, impacting ARVA assessment.
Area of Science:
- Otolaryngology
- Voice Science
- Gerontology
Background:
- Age-related vocal atrophy (ARVA) affects voice quality and daily life.
- Vocal fold bowing is a key characteristic of ARVA, quantified by the Bowing Index (BI).
- The influence of vocal fold movement (adduction/abduction) on BI is not well understood.
Purpose of the Study:
- To investigate the relationship between the Bowing Index (BI) and vocal fold tasks (adduction vs. abduction).
- To determine how different degrees of vocal fold abduction angles affect BI measurements.
- To correlate BI with clinical severity ratings in patients with ARVA.
Main Methods:
- Flexible video laryngostroboscopy was performed on 22 ARVA patients during an alternating voice-sniff task.
- The Bowing Index (BI) was measured during non-phonatory frames as vocal folds moved from adduction to full abduction.
- Clinical severity ratings were obtained and compared with BI measurements.
Main Results:
- Mean BI was significantly higher during vocal fold abduction (8.15) compared to adduction (6.34).
- BI was greatest at 40%-60% maximal abduction, exceeding measurements at 80%-100% abduction.
- Mean BI increased with clinical severity, with the severe case showing a BI of 14.62.
Conclusions:
- Vocal fold bowing in ARVA is significantly influenced by the degree of opening and the adduction/abduction task.
- Pronounced vocal fold bowing occurs during semi-abduction, suggesting this angle is critical for BI assessment.
- Further research is needed to standardize BI measurement for ARVA evaluation.
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