Transcript Differentiating the Aging Voice from Disease

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 massdecrease 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
Structure
Nature of Aging
Change
Gender
Differences
Cartilages
Ossification &
calcification
More extensive,
earlier onset in
males
Cricoarytenoid
joint
General deterioration
More evident in
males
Intrinsic
muscles
Atrophy
In males- limited
data in females
Epithelium
Thickening
Progressive in males
until 70, declines
thereafter
Progressive in
females after 70
From Linville, Vocal Aging
Perceptual Age-related changes
Male Female
Determine age from voice
sample
Classify into age groups
X
X
X
X
Pitch changes
X
X
Hoarseness
X
X
Breathy
X
X
Slow rate
X
X
Physiologic Age-related
changes
Male
Vital capacities
Lung pressures
Peak airflow rates
Leakage airflow rates
Female
Smaller Smaller
Lower
Greater
Greater
Lower
Acoustic Age-related changes
Male
Female
Avg Fund Freq
Fo variability
Freq Pertubation
Higher
Greater
Greater
Lower
Greater
Greater
Fo range
Avg Intensity level
Variability of Intensity
Intensity range
Smaller
Smaller
Smaller
Smaller
Smaller
Smaller
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
primary
tumour
Supraglottic
Early Disease Advanced
Disease
Disturbance of
Swallowing
Hoarseness,
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
– Thyroplasty
– Injection
– Surgical correction

Voice Therapy
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
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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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