Did you ever speak to someone on the phone and detect that they are older just by the sound of their voice? It’s not your imagination; voices do age over time for a variety of reasons, i.e., vocal muscles atrophy, their voice begins to sound older.  However, illness, medications, depression and anxiety can also impact a person’s ability to speak with a clear voice.  Some of these factors impact the vocal cords themselves while others impact the person’s ability to use their voice. It is possible to protect one’s voice while aging. Here is what you need to know.

Voice function and types of impairments
The voice works1 when lung pressure forces air through bands of tissue called the vocal folds. The air pressure creates energy that hits the folds and causes them to vibrate, or oscillate, creating sound. However, if anything impairs the vocal folds or the ability to use them, the voice can change, making it sound older. Some of the factors that can impair the voice include:

  • Growths on the vocal cords such as tumors, nodules or polyps
  • Aging that causes the muscles of the vocal folds to atrophy
  • Aging that causes the voice to tire quickly
  • Depression and/or anxiety that prevents a person from using full lung pressure to create sound from the vocal folds

Any of these issues may make it harder for the vocal folds to function properly. When that happens, the person has to put more effort into using his or her voice and that can quickly tire the voice muscles. This can result in hoarseness or a scratchy sounding voice.

A study published in the clinical journal Age2 found there was no relationship between age and the ability to produce a high or low voice with the amplitude or frequency needed. In other words, the physical ability to speak in a high or low voice is preserved in aging but is impacted by depression and anxiety in the elderly. The study concluded that “while voice production undergoes important changes through aging, the ability to increase/decrease the amplitude and frequency of the voice are preserved.” The authors believe that depression and anxiety have a “stronger impact on perceived voice quality” than any acoustical changes that may occur in the physical voice mechanism. In other words, if seniors become socially isolated or suffer increasing depression or anxiety, they may lose the will to use their voice fully and energetically, causing it to sound weaker and older.

Voice disorders are common
A study on the aging voice by The George Washington University3 estimates that approximately 30 percent of people in the United States will experience a voice disorder during the course of their lifetime. A much higher percentage, around 60 percent, will experience it if they use their voices frequently, as in the case of teachers and singers. As the population continues to age it is anticipated that voice disorders will occur at a rate of 12 to 35 percent.

A national database study published in The Laryngoscope4 reviewed clinical data of 60,773 patients aged 65 plus who had received a laryngeal/voice disorder diagnosis. The review found that the most frequent diagnoses were:

  • Acute and chronic laryngitis
  • Nonspecific dysphonia (raspy, strained or hoarse voice)
  • Benign (noncancerous) vocal fold lesions

A diagnosis of dysphonia and vocal fold paralysis was more common in older patients.

Diagnosis of voice disorders
An ear, nose and throat (ENT) doctor can diagnose the cause of vocal problems and recommend treatments to improve and/or protect the voice. A diagnosis is reached after the physician collects important medical information and conducts a physical exam. It’s important to understand all the causes that may contribute to the voice disorder in order to properly treat it. A diagnosis is made after conducting any or all of the following steps:

  • Collecting a medical history of the individual
  • History of the voice disorder itself – length of time it has existed, when it occurs, etc.
  • Thorough exam of the head and neck
  • Examination of the larynx (voice box)
  • LEMG, a test to measure the function of the laryngeal muscles
  • Voice lab function test with a speech-language pathologist
  • X-rays, CT scans, MRI imaging to detect the presence of tumors or masses

Treatment for voice disorders
Once a diagnosis is made of a laryngeal/voice disorder, there are three main types of treatment5 a physician may select to address the disorders. They include medical and surgical treatments and voice therapy. The specific treatment or combination of treatments selected for any individual depends upon the diagnosis of the causes of the voice disorder.

Medical treatments:

  • Anti-reflux medications may be used to treat acid reflux that causes laryngitis
  • Medications may treat underlying causes of a voice disorder including low thyroid hormone levels, depression and anxiety.
  • Injections of botulinum toxin, type A, may work for those experiencing muscle spasms in the vocal muscles

Surgical treatments:

  • Phonomicrosurgery: This procedure is performed with a microscope and can remove lesions and other obstructions like nodules and polyps on the vocal folds
  • Laryngeal framework surgery: This improves the vocal folds and their function, allowing them to close properly to produce the voice
  • Injection augmentation: Substances like fat are injected to increase the size of the vocal fold tissues so they will close appropriately

Voice therapy:
This therapy, conducted by a speech-language pathologist, guides the person through various exercises using their voice to strengthen vocal muscles. Voice therapy may be the first course of treatment to address injury to the vocal muscles from overuse. It is also used to help those recovering from vocal surgery.

Ways to protect your voice
The voice is essential to communication with one another and the function we depend upon to express ourselves. It stands to reasons that protecting the voice is one of the most important things one can do. Ways to protect the voice include:

  • Drink plenty of water to keep the voice and the body well hydrated. Most clinicians recommend drinking six to eight 8-ounce glasses a day.
  • Limit the amount of caffeine or alcohol you drink which can dry out the vocal chords.
  • Don’t smoke.
  • Rest your voice when sick because illness stresses the vocal muscles.
  • Avoid talking loudly in noisy places or yelling frequently. Both strain the voice muscles

When it comes to our health, the voice probably isn’t the first bodily function we think about protecting. However, now that you know how frequently voice disorders occur you can take the necessary steps to protect yours. If you or a loved one experiences frequent hoarseness or other voice impairments, consult an ENT for diagnosis and treatment.

1,3: https://hsrc.himmelfarb.gwu.edu/gw_research_days/2016/BME/1/
2: https://link.springer.com/article/10.1007/s11357-015-9854-1
4: http://onlinelibrary.wiley.com/doi/10.1002/lary.25511/full
5: https://voicefoundation.org/health-science/voice-disorders/overview-of-diagnosis-treatment-prevention/treatment-of-voice-disorders/