The Aging Voice and
Differentiating Diseases
Laurie Kozlakowski
Introduction
Voice quality of the aging voice and
disease (cancer of the lanrynx) have
similar characteristics
They can both be described as hoarse,
shaky, breathy, weak, and altered pitch
Voice changes in the elderly are more
likely to be influenced by disease rather
than by physiologic aging
Study done by Woo (1992) of 64 patients
aged 65 and older found that only 11 had
functional problems related to aging
-the others had lesions, cancer, or
inflammatory problems
Normal Changes in the Aging
Voice
Decrease in breath support
-result in weakened voice
-try to compensate by sphyncterically contracting their
larynx during phonation, producing a strained quality-
muscular tension dysphonia
Laryngeal changes
-ossification of laryngeal cartilages and joints may cause
“bowing” of the vocal folds which is probably the most
common benign pathology of the aging voice—visible with
an endoscopic exam
-loss of vocal fold massdecrease patients ability to bring
the vocal folds together- weak, breathy voice
Young vs. Aged vocal folds
Young (healthy) Aged
Normal Changes Con’t
Other changes…
-changes in the cricoarytenoid due to
aging may account for some of the pitch
variability
-men, beginning in the 60’s and each
decade after-vocal cords become thin and
atrophied resulting in a higher pitched
conversational voice
-women, pitch seems to get lower through
life—vocal cords may become more
polypoid after menapause due to estrogen
deprivation which causes substantial
changes in mucous membranes that line
the vocal tract
Presbylaryngis
age related structural changes of the
vocal folds- may cause glottal gap
during voice production
Woo, “presbylaryngis is not a
common disorder and should be a
diagnosis of exclusion made only
after careful medical and speech
evaluation”
Aging in the Larynx
Laryngeal Nature of Aging Gender
Structure Change Differences
Cartilages Ossification & More extensive,
calcification earlier onset in
males
Cricoarytenoid General deterioration More evident in
joint males
Intrinsic Atrophy In males- limited
muscles data in females
Epithelium Thickening Progressive in males
until 70, declines
thereafter
From Linville, Vocal Aging Progressive in
females after 70
Perceptual Age-related changes
Male Female
Determine age from voice
X X
sample
Classify into age groups X X
Pitch changes X X
Hoarseness X X
Breathy X X
Slow rate X X
Physiologic Age-related
changes
Male Female
Vital capacities
Smaller Smaller
Lung pressures Lower Lower
Peak airflow rates
Greater
Leakage airflow rates
Greater
Acoustic Age-related changes
Male Female
Avg Fund Freq Higher Lower
Fo variability Greater Greater
Freq Pertubation Greater Greater
Fo range Smaller Smaller
Avg Intensity level Smaller Smaller
Variability of Intensity Smaller Smaller
Intensity range Smaller Smaller
Speaking rate Slower Slower
Pathological Conditions
Infections of viral, bacterial, or fungal
origin
Inflammatory autoimmune disease
Neoplasms (benign or malignant)
Vocal cord paralysis
Thyroid function problems
Functional and psychogenic disorders
Patients who have undergone surgical
procedures or emergent intubation will
have pathological changes in larynx for
weeks, months, or permanently
Diagnostic Clues
Laryngeal or hypopharyngeal cancer is
suggested by…
-voice changes of recent onset (several
weeks to months)
-associated pain with phonation
-associated pain or difficulty swallowing
-presence of new neck mass
These findings coupled with a significant
past history of alcohol or tobacco use
should alert the clinician of cancer-refer
to otolaryngologist
Polyp or granuloma
-vocal fatigue and pitch changes
Normal vs. Cancerous
Normal Cancer (beginning
stage)
Early and Advanced Signs of
Cancer
Location of Early Disease Advanced
primary Disease
tumour
Supraglottic Disturbance of Hoarseness,
Swallowing dysphagia
Glottic Hoarseness Airway
obstruction
Subglottic Mild haemoptysis Hoarseness,
airway
obstruction
Treatment
Time- most useful in distinguishing benign
from malignant etiologies of hoarseness
-2 weeks of symptomatic treatment w/
voice rest and increased hydration will
often allow infectious or inflammatory
disorders to resolve without adversely
affecting the prognosis if the cause of the
hoarseness is a malignant neoplasm
Treatment Options for the Aging
Voice
Surgery Voice Therapy
– Thyroplasty
– Injection
– Surgical correction
Voice therapy should focus on…
Improving overall physical fitness
-maintain muscle function and coordination
-helps vascular system
-helps nervous system
-improves respiratory system
Counseling on good vocal hygeine
Improving respiratory eficiency
-decrease residual volume
-increase vital capacity
Increasing speed of speech
Proper nutrition and weight control
-good abdominal support=strong, less shaky voice
LSVT as Treatment
(study)
Used to evaluate changes associated with
vocal aging before and after treatment
Patients had hoarseness and reduced
volume
16 sessions in a 1 month period
Results: increased phonatory efficiency
-increase in sound pressure level
-improved vocal fold adduction
-increased respiratory-laryngeal-vocal tract
coordination
References
Boone, D. & McFarlane, S. (2000). The voice and
voice therapy. Boston: Allyn and Bacon.
Ramig,L., Gray, S., Baker, K., Corbin-Lewis, K.,
Buder, E., Luschei, E., Coon, H., & Smith, M.
(2001). A review, treatment data and familial
and genetic perspectives. Folia Phoniatrica et
Logopaedica, 252-65.
Sataloff, R, Rosen, D., Hawkshaw, M., & Spiegel,
J. (1997). The aging adult voice. Journal of
Voice, 156-60.
Sinard, R. & Hall, D. (1998). The aging
voice: How to differentiate disease from
normal changes. Geriatrics, 53(7), 76-79.
http://www.sandgovoice.org/presby.html
http://www.hopkinsmedicine.org/voice/index.htm
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