Phonosurgery in the elderly: a review.

Surgery in the elderly requires a knowledge of the changes in the larynx that take place with aging. In the elderly larynx, there are changes in the elastin and collagen fibers within the lamina propria. There is also thinning and atrophy of the mucous membranes and atrophy of the mucous glands. Common disorders are vocal fold atrophy, sulcus vocalis, glottic incompetence, and vocal fold edema. A reduction in the number of lymphatic channels is responsible for the vocal fold edema. Vocal fold atrophy is responsible for the increase in pitch that is frequently heard in elderly men. Other common conditions in the elderly include vocal fold nodules, polyps, and Reinke's edema. The most common phonosurgical procedures performed in the elderly are vocal fold surgery for benign pathology and laryngeal structure surgery for glottic incompetence. Microsurgical techniques on benign vocal fold lesions aim to avoid injury to the transitional layer, which is rich in fibroblasts. Although the superficial layer of the lamina propria involves less fibroblastic activity, any surgical manipulation of the lamina propria can influence the vibratory properties of the vocal folds, particularly when the basement membrane zone is manipulated. The alterations in phonosurgical techniques used in the elderly are the result of histologic changes in the vocal folds and altered wound healing. Functional voice disorders often develop to compensate for the structural changes in the larynx. Correction of hyperfunctional or abnormal functional technique is as important as phonosurgical correction of vocal fold pathology.