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lamina propria collagen modulation, opening new perspec-

tives for presbyphonia and vocal fold atrophy treatments.

25,28

The basement membrane and the vessels endothelium

having a structural function, they also contain collagen

types IV and V, which contribute to support the lamina pro-

pria.

As in our results, it was observed that these antibo-

dies, when quantified in said locations, also increased with

age (

Table 2

). Similar results have been reported in lar-

ynges with chronic inflammation in morphological studies.

The increase of said collagens is probably related to the

simultaneous increase of blood vessels, which is observed

with both persistent inflammation and aging.

Elastic fibers in the elderly larynx not only are found

in lower amounts but also present structural alterations.

Sato and Hirano

observed that with aging, these fibers

lose elasticity because of an increase in amorphous sub-

stance, a decrease in microfibrils, and their metabolic

alteration. Thus, we can infer that synchronicity of the

phonatory system can depend on biomechanic changes,

due to the physiological remodeling of the extracellular

matrix.

We can therefore stress that the vibration mechanism of

vocal folds is governed by the laryngeal tissue biomecha-

nics. The observed alterations in the elderly larynx lamina

propria components are interpreted in the endoscopic exami-

nations as vocal fold atrophy and spindle chink, giving the

voice different degrees of hoarseness, asthenia, and breathi-

ness.

These ‘‘new’’ micro- and macroanatomic configura-

tions present in the elderly larynx may mirror age-dependent

physiological remodeling; that is, the structural changes in

the vocal folds lamina propria that occur with aging make it

necessary for the extracellular matrix and its components to

be remodeled to remain functional.

Conclusions

In our methodological conditions, we observed in the vocal

folds lamina propria a clear increase of collagens I and III,

Figure 5.

Vocal folds. (A) Control group: collagen IV staining the vessel endothelium (arrow). (B, C) Elderly groups: collagen IV staining

the vessel endothelium and the basement membrane (arrows). Immunohistochemical reaction, 20

Figure 7.

Vocal folds. (A) Control group: uniform elastin antibody staining the lamina propria. (B, C) Elderly groups: sparse distribution of

elastin in the lamina propria. Imunohistochemical reaction, 20

Figure 6.

Vocal folds. (A) Control group: collagen V staining the vessel endothelium (arrow). (B, C) Elderly groups: collagen V staining the

vessel endothelium and the basement membrane (arrows). Immunohistochemical reaction, 20

Otolaryngology–Head and Neck Surgery 152(2)