Characterizing the Speech Breathing Kinematics of Older Adults With Presbyphonia

Age-related changes to laryngeal and respiratory systems contribute to presbyphonia, yet the speech breathing behaviors that accompany or exacerbate ageing voice problems remain poorly characterized. This study examined speech breathing kinematics in older adults with presbyphonia and compared them with published data from vocally healthy peers.

Thirty-five adults with presbyphonia (20 men, 15 women; M_age = 79.8 years) completed reading and monologue tasks in comfortable and background noise conditions while inductive plethysmography and calibrated acoustics were recorded. Primary outcome was lung volume initiation (LVI) expressed as % vital capacity (%VC) relative to end-expiratory level. Secondary measures included lung volume termination (LVT), lung volume excursion (LVE), LVE per syllable, expiratory flow, inspiratory flow, utterance length, rate of speech, and sound pressure level. Group and noise condition comparisons were made against normative cohorts using two-sample t tests and descriptive comparisons; mixed-effects models assessed utterance length effects.

Compared with typical older adults, participants with presbyphonia initiated speech at significantly lower LVI across tasks and loudness conditions (mean difference monologue: -8.8 %VC and -15.4 %VC, p = .004 and p < .001; mean difference loud monologue: -11.5 %VC, p = .008; mean difference oral reading: -7.8 %VC, p < .001). They also showed descriptively smaller LVE, shorter utterances, faster speech, higher expiratory flows, and markedly lower inspiratory flows. In noise, presbyphonic speakers increased LVI, LVE, and inspiratory flow, whereas typical older adults did not. Utterance length influenced LVI, LVT, rate of speech, and expiratory flow in both groups, though presbyphonic speakers exhibited greater expiratory flow reductions and smaller speech rate increases from already elevated baselines.

Older adults with presbyphonia show a distinct speech breathing profile: lower LVI, reduced LVE, shorter utterances and faster rates of speech, elevated expiratory flow, and lower inspiratory flow, all of which partially normalize with increased speech intensity. These findings suggest that altered respiratory kinematics may be part of the symptomatology of presbyphonia. Clinical management should consider speech breathing alongside laryngeal-focused interventions. Future studies should include contemporaneous, well-matched controls and determine whether respiratory-focused therapies improve speech breathing patterns and voice outcomes.