Treatment Decisions in Presbyphonia

Introduction: Presbyphonia, age-related dysphonia from vocal cord atrophy, can impair communication, social engagement, and professional performance. Treatments vary in invasiveness and efficacy, but factors influencing patients’ decisions remain largely unexplored.

Methods: A qualitative interview study rooted in grounded theory used an interpretive framework to examine patient decision-making in presbyphonia treatment. Twelve participants aged ≥65 completed semi-structured interviews at a single institution between April 2025 and January 2026. Two investigators independently analyzed transcripts using thematic content analysis, resolving discrepancies through discussion.

Results: Consistent with prior studies, participants reported challenges with voice quality, projection, and clarity, and frustration with symptom variability and progression. Several specifically noted difficulty being heard, needing to push themselves to speak, and reduced vocal flexibility. Participants reported challenges in occupational and social settings, occasionally leading them to avoid talking. Previous treatments included amplification devices, GI evaluation, and local throat therapies. Participants described emotional impacts, including anxiety about their voice, concern for worsening, and feelings of weakness. Motivations for seeking care included preventing further decline, using the voice more freely, increasing volume, and ruling out underlying pathology. Treatment priorities emphasized rapid improvement, maximum effectiveness, minimal invasiveness, and reassurance that no serious pathology required urgent attention. Some participants also reported barriers to treatment, including other health problems, financial burdens, and limited time to focus on their voice.

Conclusions: Adults with presbyphonia face distinct functional, emotional, and social challenges and have clear motivations, concerns, and treatment preferences. Recognizing the interplay of these factors is essential for providing individualized care that aligns with this population’s values.