The aging voice
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The Aging Voice. Presented by Anastasia Serbalik Presented to Rebecca L. Gould, MSC, CCC-SLP. Increasing need for Geriatric Otolaryngology. During the 20th century the number of persons in the U.S. under 65 has tripled

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The aging voice l.jpg

The Aging Voice

Presented by Anastasia Serbalik

Presented to Rebecca L. Gould, MSC, CCC-SLP


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Increasing need for Geriatric Otolaryngology

  • During the 20th century the number of persons in the U.S. under 65 has tripled

  • The number of people over 65 has increased by 11 times during the 20th century!

  • By the year 2050 1/5 people will be 65 or older


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Increasing need for Geriatric Otolaryngology

  • Vocal disturbance is among one of the top medical complaints of the elderly

  • An estimated 12% of the elderly have vocal dysfunction


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Aging: Changes in Respiratory Support

  • Decreased vital capacity-decrease by one liter for both males and females

  • Loss of efficiency-loss of elasticity in thoracic skeleton, muscular weakness

  • Reduction of loudness


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Aging: Changes in laryngeal mechanism

  • Calcification and Ossification of laryngeal cartilages

  • Degeneration of laryngeal muscles

    • Thickening of connective tissue of lamina propria

    • Thinning of intermediate layer of lamina propria

    • “densening” of deep layer of lamina propria


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Changes in Laryngeal Mechanism: Males & Females

*In women vocal folds become more edamatous and polyploidy

*In men vocal folds become

more thin and atrophied


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Aging: Changes in Laryngeal Mechanism

  • Changes in the cricoarytenoid joint

    - pitch of voice is fine-tuned by control over position of arytenoid cartilage which may account for pitch variability

    • Restriction of vocal fold approximation


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Changes in Supralaryngeal Mechanism

  • Atrophy of facial, pharyngeal, and mastication muscles

  • Weakened esophageal sphincter may lead to gastro esophageal reflux


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Aging: Changes in Supralaryngeal system

  • Craniofacial enlargement by 3-5%

  • Changes in articulators-loss of teeth, reduced musculature of tongue and masticular muscles affect resonation


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Functional Effects of Age Related changes of the Voice

  • After fifth decade of life increase in male fundamental frequency in males (35 Hz)

  • Decrease in fundamental frequency of women (10-15 Hz)

  • Increase in pitch perturbation cycle to cycle variation of fundamental frequency

    • difficult to maintain a stable tone


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Functional Effects of Age Related Changes of the Voice

  • Reduced pitch range

  • Decreased sound pressure level

  • Vocal quality symptoms of vocal

    roughness, aperiodicity, breathiness


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Common Vocal Fold Findingsin the Elderly

  • Bowed cords

  • Atrophy

  • Edema

  • Loss of collagen, ground substance, and cartilage matrix in the cricoarytenioid joint

  • Atrophy of laryngeal muscles


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Bowed Vocal Fold

  • Most common benign pathology of the aging voice

  • Gap occurs in the region of the middle one-third of the vocal cord with total or near approximation at anterior and posterior commisures


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Atrophic Vocal Folds

  • With advancing age the vocal fold muscle and mucosal covering can lose mass, appearing as thinned

  • Incomplete closure of vocal folds and irregular vibration


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Edema

  • Swelling of the entire layer of superficial lamina propria

  • Water balloon effect

  • Result in irregular mucosal wave


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The Aging Voice: The Challenge of Diagnosis

Factors:

1. Identification of normal aging voice from pathological condition

2. Inappropriate/insufficient assessments

3. Incomplete/inaccurate Case history


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“It is important to remember although vocal changes often occur with aging they occur in many other pathological states”

(Linville, 2004)


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Differential Diagnosis: Pathologic conditions vs. normal aging voice

  • Inflammatory and Autoimmune diseases

  • Neoplasms-abnormal new mass of tissue serving no purpose (benign & malignant) can occur in larynx or thyroid

  • Functional and psychogenic disorders of speech

  • May be misconstrued as part of normal aging


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Differential Diagnosis: Pathologic conditions vs. normal aging voice

  • Essential tremor

  • Parkinson’s disease

  • Stroke

  • Myastehnia gravis

  • Amyotrophic lateral sclerosis


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Differential Diagnosis:Aging voice vs. pathologic condition aging voice

  • HOARSENESS is both a quality frequently found in normal aging voice AND one of the most common symptoms of vocal dysfunction…so how do we differentiate malignant from benign etiologies of hoarseness


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Diagnosis of the aging voiceAging Voice:Useful tools

  • TIME is the most useful therapeutic

    measure that may help to distinguish benign from malignant etiologies of hoarseness

  • REFERRAL to the otolaryngologist to perform a thorough laryngeal exam is an invaluable resource in diagnosis and management of hoarseness

  • CASE HISTORY-elements of a patients history and symptomology are gateways in forming appropriate diagnosis


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Differential diagnosis:Aging voice vs.. disordered voice aging voice

  • Indicators hoarseness is NOT due to Benign

    changes

    • Voice changes of recent onset

    • Associated pain with phonation

    • Pain or difficulty swallowing

    • Presence of new neck mass

    • Past history of alcohol or tobacco use


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Diagnosis of the Aging Voice: Assessment aging voice

  • Until recently Speech Pathologists had very little data to indicate the normal voice and speech patterns of the elderly

    TAKE A LOOK AT THIS…..


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The Aging Voice & Diagnosis aging voice

  • 1998 Sinard & Hall reported “there are no objective tests that can reliably distinguish voice changes due to normal aging process from disease of the larynx”

  • 1999 Whitlock reported the need for an acoustical test to accurately monitor potential voice disorders

  • 2004 Verdonck-de Leeuw & Mahieu report a lack of longitudinal studies on the effects of aging on voice


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Diagnosis of the Aging Voice: Advancements in Assessment aging voice

  • Recent longitudinal research study conducted by Verdonck-de Leeuw & Mahieu used Multidimensional Voice Program to acoustically analyze eight parameters of voice by digitizing sustained vowels and fragments of speech

    • Omnidirectional telephones

    • Custom-made amplifiers

    • DAT recorder


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Findings of Longitudinal Study on vocal aging and impact on daily life:

Significant deterioration of voice as soon as 5 years after age 50

  • Voice instability, changes in fundamnetal frequency

  • Tendency to avoid social parties increase in isolating behaviors

  • Male smokers with irreversible lower fundamental frequencies

(Veronck-de Leeuw & Mahieu, 2004)


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Findings of Longitudinal Study on vocal aging and impact on daily life

THE LATEST NEWS: histological & genetic findings of recent studies give rise to a theory that aging will inevitably lead to a mild-moderate-severe voice impairment

(Veronck-de Leeuw & Mahieu, 2004)


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New Research: How voice gives away a person’s age daily life

  • Researchers identified key indicators of the aging voice

  • Used computer software to speed up and lower voices of older men to sound younger

  • Results found 12/13 old voices were mistook as “young”

  • Implications

    • Criminal forensics

    • Hollywood, aging of actors voices

(Ascribe Medicine News Service, 2003)


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Keeping the Voice “Young” daily life

  • “You are as young as you sound”

  • Eat sensibly

  • Get plenty of rest

  • Keep brain and voice well exercised

  • Use the strong muscles of your lower abdominals to support voice

  • Keep hydrated-8 a day

  • Be alert for voice damaging symptoms of GERD


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References daily life

  • Deem, M. & Miller, L. (2000). Manual of Voice Therapy. Austin, TX: PRO-ED, Inc.

  • Linville, S. E. (2004, Oct.19) The Aging Voice. The ASHA Leader, p.12, 21

  • Shields, Gordon. (2004, June 16). Geriatric Otolaryngology

  • Spotlight on Special Topics in Voice Disorders (2004) In The New York Eye and Ear Infirmary, Center for Voice. Retrieved June 10, 2005, from http://www.nyeee.edu/cfv-spotlight


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References daily life

  • Ordonez, Ernesto A. (2000)‘Growth of anti-aging field offers new career option’. A voice of experience p.16, I.12).

  • Research uncovers How the voice gives away a person’s age. (2003) Ascribe Medicine News Service.

  • Sinard, R. & Hall, D. (1998). The aging voice:how to differentiate disease from normal changes. Geriatrics, p.76


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References daily life

  • Verdonck-de Leeuw, Irma & Hans F. Mahieu (study. Journal of Voice 2004). Vocal aging and the impact on daily life: a longitudinal, 18, 193-203. 53.

  • Whitlock, Kelly (1999). Age-Related Vocal Changes Often Misdiagnosed. Science Daily.


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