Earlier this week, I wrote about our ethical obligation to clinical competence. I mentioned that one area I lack competence is voice therapy. I am thankful to be in a situation where I refer voice patients to my colleague, Mandy Politziner who is an SLP and vocalogist. I asked her to lay some groundwork for understanding normal aging in terms of voice in the blog post today. Thanks Mandy!
Typically after the age of 60, men and women’s voices begin to change. For those of us who work with elders, we know elders’ voices do not sound like our own. Buy why? What exactly is happening to the voices of our elders? The following are examples of changes that can occur in our voices as we age.
Typically beginning in the sixth decade, laryngeal tissues begin to atrophy, or waste away. The vocal folds generally atrophy towards the lateral direction, which results in vocal fold bowing, in which a gap forms between the vocal folds. Atrophy may also cause the structure of the tissue itself to change. Parallel strands of muscle fiber may become fibrous, or criss-cross in shape. This change in shape of fibers may cause irregularities in the mucosal wave of the vocal folds.
A clinician may hear weakness, soft volume and/or breathiness with atrophy, as well as a decreased pitch range.
Neural cell changes
Another change that inevitably happens to many areas of the body with aging is that the neural cells may not function optimally like they used to. Whether through degeneration or malfunction of neural input, the result may be a change in muscle tone of the larynx, and a change in regularity of muscle contraction.
With malfunctioning of the neural cells, a clinician may hear that distinctive “wobble” in the voice that we associate with old age, as well as weakness in the voice.
Laryngeal ossification, in which cartilage changes to bone, typically starts at the age of 30 and slowly increases until around our 80’s. The good news is that this hardening of the structures can lead to greater stability in the voice, as the voice has somewhat of an anchor for the ever-changing movements in the larynx. The bad news is that ossification can lead to lack of agility of the voice. This is particularly stressful to our elders who sing. For those of our elders who sing in their local community or religious choirs, this lack of agility can be particularly upsetting to them.
With laryngeal ossification, a clinician may hear difficulty with a patient’s ability to change pitches quickly and freely.
Just as someone can get arthritis in their fingers or toes, the elderly can get arthritis in the joints of the larynx. Due to inflammation, these joints may become limited in their movement, affecting adduction, abduction, and cricothyroid movement.
With laryngeal arthritis, a clinician may hear limited pitch range.
Personally, I have heard more roughness in my patients’ voices than weakness. Roughness may be caused by edema, which can also manifest as we age. Edema is swelling caused by excess fluid in the vocal folds. The excess fluid can disrupt the mucosal wave pattern.
With edema, a clinician may hear vocal roughness.
Hormonal changes may be the contributing factor to change in fundamental frequency as we age. The male voice gets higher with age, and the female voice gets lower, possibly due to decreasing testosterone and estrogen levels. After men and women are well into their 80’s, their voices may be indistinguishable from each other.
Potentially due to hormonal changes with aging, the clinician may hear a low voice in a female (below 200 Hz) and a high voice in a male (above 150 Hz).
These are examples of typical changes of the aging voice. Of course, certain populations can beat the odds and maintain a healthy voice as they age, such as those who are trained singers or speakers.
It is important to note that this list contains examples of occurrences in the normal aging process, and does not rule out that your patient does not have an actual voice disorder. If you or your patient suspects a voice disorder, send your patient for an otolaryngologist evaluation
Titze, I.R. (2000). Principles of Voice Production (2nd printing). Iowa City, IA: National Center for Voice and Speech.
Guest blogger bio:
Mandy Politziner, MS, CCC-SLP, is a speech-language pathologist in Boulder, Colorado. She recently graduated from the Summer Vocology Institute at the National Center for Voice and Speech under the direction of Dr. Ingo Titze. Mandy has a BFA in musical theatre from the University of Michigan, and she enjoys combining her arts and science backgrounds as she works with her clients at her skilled nursing facility.
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