Objective <p>This study aimed to identify the most useful clinical parameters to inform the physician-patient therapeutic discussion and determine which parameters predict therapeutic choice in presbyphonia. We studied the vocal parameters of a cohort of patients diagnosed with presbyphonia with endoscopic signs of presbylarynx, analyzing several voice parameters by age subgroups and by presbylarynx type according to the Santos classification.</p> Methods <p>A retrospective analysis was conducted on 88 patients (51 women, 37 men; mean age 74.16 ± 6.87 years) with presbyphonia and presenting a type 1 or 2 presbylarynx. Patients underwent a comprehensive voice assessment, including acoustic (F0, voice intensity, Jitter, and HNR), aerodynamic (MPT, oral airflow (OAF), and estimated subglottic pressure (ESGP)), and perceptual assessment (GRB scale of Hirano), as well as a voice self-assessment score. We used multinomial logistic regression to assess the association between different parameters and treatment choice (monitoring, speech therapy, or injection).</p> Results <p>Perceptual parameters were significantly associated with age, with overall grade (G) and roughness (R) scores progressively worsening. Patients who received vocal fold injections presented with a significantly higher self-assessment score (<i>p</i> = 0.0148). Patients who received speech therapy had a significantly lower overall dysphonia grade (G) score (<i>p</i> = 0.0281) compared to those monitored. Notably, a significant association was observed between Santos presbylarynx type and treatment choice (χ² = 34.64, <i>p</i> &lt; 0.001), with type 1 patients primarily receiving voice therapy and type 2 patients receiving injections. Acoustic and aerodynamic parameters showed limited significant associations with treatment decisions.</p> Conclusion <p>The most clinically useful parameters to guide treatment decisions in presbyphonia appear to be perceptual voice analysis, patient self-assessment, and presbylarynx type. Objective acoustic and aerodynamic measures demonstrated non-significant changes within this cohort and were of limited utility in this setting. These findings highlight the importance of a multidimensional assessment integrating subjective (patient self-assessment) and perceptual data (G score) with anatomical findings (presbylarynx type). These factors serve as essential measurable inputs to inform a therapeutic decision that remains ultimately subjective, shared, and centered on patient demand.</p>