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Treating Age-Related Voice Changes

NEW YORK (Mar 10, 2014)

Wrinkles and thinning hair are among the most noticeable signs of aging, but internal structures of the body such as the vocal cords are susceptible to the aging process as well. Known as aging voice, or presbyphonia, the condition occurs as the mucous membranes of the vocal cords thin and become dry, leading to a noticeable change in the voice.

Chandra M. Ivey, M.D.
Chandra M. Ivey, M.D.

Although presbyphonia is not a new phenomenon, an increasing number of patients older than 60 years of age are visiting otolaryngologists with complaints of voice changes. Doctors at NYP diagnose and treat the condition, helping the elderly to strengthen their voice. Commonly, patients complain of difficulty being heard in noisy situations, tremor or shakiness in the voice, and reduced volume and projection, or "thin" voice.

If a visit to a voice specialist is warranted, a videostroboscopy of the larynx will be performed to examine the function and motion of the voice box and vocal cords. "When we see the videostroboscopy of older patients, quite often it shows a loss of tissue layers – a thinning of the vocal cords as they come together," said Chandra M. Ivey, M.D. "Another test we do is pressing slightly on the front of the larynx, which allows the vocal cords to be pushed a little bit closer together. Sometimes the voice gets a little lower or a little more resonant."

The portion of the vocal fold that vibrates during phonation requires certain elastic properties and age-related factors have been shown to contribute to voice change. "Collagen types 1 and 2, as well as the elastic components of this structure, change as people get older and decrease slowly over time. This causes thinning and decreased pliability of the mucosal wave, and the result is the need to increase muscle tension and force to vibrate the vocal folds," explained Dr. Ivey.

A proper diagnosis by a vocal specialist is paramount. Some patients may have medical problems that affect their voice. For example, significant weight loss may cause thinning of the vocal cords. "Any other condition that may cause dryness or irritation can certainly worsen the voice and needs to be treated as a secondary problem," she said.

Treatment for a diagnosis of presbyphonia may entail administering collagen or gelatin injections to augment the vocal folds, a procedure that is unique to the skills of a laryngologist. The injectable material, which is gradually reabsorbed by the body, is usually effective for about 4 to 6 weeks. Other vocal fold injections can last from 6 to 9 months. "These injectable materials are safe," said Dr. Ivey.

Dr. Ivey also treats professional voice users. "While we can't take them back 20 years in their career, we can often take them back 3 to 5 years. Managing expectations for the aging professional is different than for other patients."

If a patient receives a diagnosis of vocal fatigue, Dr. Ivey and her team examine how the patient's voice is being used. "A lot of people are having increased vocal demands because they are working much later past a previously normal retirement age," said Dr. Ivey. "The majority of our older patients are continuing to work in part-time or full-time positions that require them to project their voice – as in a courtroom or in a classroom." She noted that with aging, patients lose breath support and tend to push with their throat muscles, which leads to vocal fatigue. Treatment may include working with a voice therapist and adhering to an exercise regimen to help recondition the vocal cords and to increase muscle strength. "Greater than 50% of patients – while not expecting to regain their former plump vocal cords – embrace this regimen without further need for surgical intervention," said Dr. Ivey.

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