The Laryngoscope V C 2015 The American Laryngological, Rhinological and Otological Society, Inc. Voice Disorders in the Elderly: A National Database Study Nelson Roy, PhD, CCC-SLP; Jaewhan Kim, PhD; Mark Courey, MD; Seth M. Cohen, MD, MPH Objectives/Hypothesis: To determine the type, frequency, and factors associated with voice disorders in the elderly. Study Design: Retrospective analysis of data from a large national administrative US claims database. Methods: Elderly outpatients (>65 years old) with a laryngeal/voice disorder (LVD) diagnosis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes from January 1, 2004 to December 31, 2008, seen by an otolaryngologist or primary care physician (PCP) were included. Data regarding age, gender, comorbid conditions, geographic location, employment history, and type of physician providing the diagnosis were collected, and multiple logistic regression was used to determine the influence of these factors in otolaryngologist-determined LVD diagnoses. Results: Of the almost 55 million individuals in the database, 60,773 unique patients (mean age 5 74.9 years, standard deviation 5 6.6 years, range 5 65–105 years) had an encounter with a PCP or otolaryngologist and received an LVD diagnosis. The most frequent diagnoses overall were acute and chronic laryngitis, nonspecific dysphonia, and benign vocal fold lesions. PCPs more commonly diagnosed acute laryngitis, whereas otolaryngologists more commonly diagnosed nonspecific dysphonia and laryngeal changes/lesions. In the otolaryngology group, odds of nonspecific dysphonia and vocal fold paralysis/paresis diagnoses increased with advancing age, whereas benign laryngeal pathology, and acute and chronic laryngitis decreased. As compared to men, women had lower odds of paralysis/paresis and laryngeal cancer but higher odds of acute laryngitis and nonspecific dysphonia. Odds of specific LVDs also varied depending upon comorbid conditions and geographic location. Conclusions: Age, gender, comorbid conditions, geographic location, and physician type were significantly associated with specific LVD diagnoses within the elderly. Key Words: Voice, dysphonia, elderly, larynx. Level of Evidence: 4 Laryngoscope, 126:421–428, 2016 INTRODUCTION Currently, there are 41.5 million older adults (>65 years old) in the United States. By the year 2030, the elderly population is projected to almost double and con- stitute over 20% of the US population. 1 It is well docu- mented that numerous age-related changes occur in the subsystems underlying voice production including changes in respiration, phonation, and resonance. 2–9 In some elderly individuals, these age-related changes and/ or declining health are sufficient to contribute to voice disorders that alter communication and negatively affect quality of life. Voice disorders are relatively common in the general elderly population, with prevalence esti- mates ranging from 19% to 29%. 9–14 The prevalence of voice disorders increases with advancing age and is highest among the elderly. 15–19 Furthermore, annual direct healthcare costs related to dysphonia increase with age, with seniors incurring the highest per person cost. 20,21 Despite this rapidly expanding elderly popula- tion and the implications for healthcare utilization and costs, relatively little is known—on a national scale— regarding the causes of voice disorders among the elderly. Clinical studies using medical record reviews of patients attending voice specialty centers have attempted to shed light on the nature of voice disorders within the elderly. The results confirm that voice disor- ders are common among the treatment-seeking elderly and may be on the rise. 22 The laryngeal diseases fre- quently reported are vocal fold paralysis and paresis, laryngopharyngeal reflux, cancer, inflammation, and neurological disorders. However, the frequency of pres- bylaryngis—a voice disorder attributed to age-related vocal fold bowing/atrophy—remains a source of contro- versy, and estimates vary substantially ranging from 0% to 30%. 23–30 Certain investigators have concluded that presbylaryngis is not common, and dysphonia among the elderly is more often secondary to disease processes (i.e., comorbid diseases) common to the elderly, rather than aging alone. 24,29 Disagreement exists among clinicians regarding the role of physiological aging versus disease processes in the development of voice disorders in the From the Department of Communication Sciences and Disorders, and Division of Otolaryngology–Head & Neck Surgery (N.R.), The Univer- sity of Utah, Salt Lake City, Utah; Division of Public Health & Study Design and Biostatistics Center (J.K.), Duke University Medical Center, Durham, North Carolina; Department of Otolaryngology–Head & Neck Surgery (M.C.), University of California–San Francisco, San Francisco, California, U.S.A. The University of Utah, Salt Lake City, Utah; Duke Voice Care Center, Division of Otolaryngology–Head & Neck Surgery (S.M.C.) Editor’s Note: This Manuscript was accepted for publication June 22, 2015. This study was funded by the American Academy of Otolaryngol- ogy–Head & Neck Surgery. The authors have no other funding, financial relationships, or con- flicts of interest to disclose. Send correspondence to Nelson Roy, PhD, Department of Commu- nication Sciences and Disorders, The University of Utah, 390 South 1530 East, Room #1310, Salt Lake City, UT 84112. E-mail: nelson.roy@health.utah.edu DOI: 10.1002/lary.25511 Laryngoscope 126: February 2016 Roy et al.: Voice Disorders in the Elderly 421