Presbyphonia: Voice Therapy vs Augmentation a Systematic Review and Meta-analysis

Introduction: Presbyphonia has a substantial negative impact on quality of life; however, there is no clear consensus on the best surgical and non-surgical treatment modalities.

Methods: A systematic review was performed of PubMed, Ovid, and Embase from 2013 to 2023 according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Additional studies were identified from review citations. Data were reviewed for demographics, preoperative data, intervention technique, and outcome measures. Study interventions were categorized as non-procedural, non-augmentation interventions, and augmentation (injection or thyroplasty). For outcome measures reported in all three intervention categories, a random effects model was performed to assess mean difference.

Results: An initial search yielded a total of 169 articles, with 21 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 all three intervention categories were voice handicap index (VHI), VHI-10, and the maximum phonation time (MPT). Overall mean difference for all interventions was -0.46 (p=0.19) on VHI, -1.18 (p=0.04) on VHI-10, and +0.66 (p=0.05) on MPT. Augmentation demonstrated higher mean effect sizes, but these differences did not reach statistical significance on VHI (A -0.89 vs FGF -0.46 vs VT -0.19; p=0.53) or MPT (A +0.91 vs FGF +0.51 vs VT +0.66, p=0.11). Similarly, VT demonstrated higher mean difference on VHI-10, but this did not reach statistical significance (A -1.15 vs FGF -1.10 vs VT -1.26; p=0.94).

Conclusions: There is no significant difference in VHI and MPT between voice therapy and augmentation for patients with presbyphonia. Unfortunately, other objective measures were not consistently reported. In practice, clinicians employ combinations of voice therapy, injection augmentation, and thyroplasty in varying order. Future prospective studies are needed to determine which treatment algorithms best serve patients with presbyphonia.