When our voices changed as we became older, it was mostly a welcome sign we were becoming adults. But as we grow older, still more changes occur in our voices, and sometimes in ways that may make communication challenging. These changes may be signs of a condition called presbyphonia.
What is Presbyphonia?
As we age, we lose muscle mass, our mucous membranes thin and become drier, and we lose some of the coordination that we had in younger years. Some of these changes are due to physical inactivity.
Similar changes occur in the larynx and vocal cords, also called vocal folds, due in part to vocal inactivity that impact our ability to speak and be heard. The symptoms of presbyphonia include:
- Reduced volume and projection of your voice
- Reduced vocal endurance, meaning more fatigue or hoarseness when talking
- Difficulty being heard in noisy situations, such as dining out
- Scratchiness or roughness in your voice
- Breathiness or weakness in your voice
- A higher-pitched voice among men
- A lower-pitched voice among women
- Tremor or shakiness in your voice
According to one recent study, approximately one in three adults ages 60 and older in the United States have one or more of these difficulties, and it can have a significant negative impact on every aspect of our lives.
Olivia Boddicker, MA, CCC-SLP
“We tend to underestimate how important our voice is until we can’t rely on it anymore. Changes in our voice make it difficult for us to do the things we love, such as reading to our grandchildren, socializing with friends, or singing with a choir,” says Olivia Boddicker, MA, CCC-SLP, a voice-specialized speech language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai.
“The changes related to presbyphonia are not necessarily dangerous, but they can affect our sense of identity and self-confidence, making it difficult to hold employment or socialize.”
How Presbyphonia is Diagnosed
Although these changes in the voice may be age related, they could be symptoms of a more serious issue. For that reason, it is important to consult a laryngologist and voice-specialized speech language pathologist to determine what is going on, rule out other causes, and start to address the problem.
The laryngologist will typically perform a complete examination of your head and neck, along with a specialized examination of the vocal cords/folds called stroboscopy. This is a simple test in which a small device called a laryngoscope is inserted in the mouth or nose to examine the larynx and assess the appearance, mobility, and vibrations of the vocal cord/folds. If the laryngologist sees that the vocal cords/folds are thin, stiffened, or have a gap between them when they close, the diagnosis is typically presbyphonia.
During evaluation, the speech language pathologist will also perform a stimulability test to see how much effort it takes for the vocal cords/folds to create different sounds. This test will help determine the best approach to treatment.
Treatments for Presbyphonia
After reviewing the stroboscopy exam with the laryngologist and speech language pathologist, patients can decide whether behavioral intervention or surgical intervention is appropriate. In many cases, behavioral intervention through voice therapy is one of the first recommendations for treating presbyphonia because it is non-invasive and proven to be effective in increasing voice-related quality of life.
Voice therapy for presbyphonia focuses on increasing projection, vocal endurance, and improving stability of the voice. Techniques and programs such as vocal function exercises, phonation resistance training exercises, and respiratory muscle strength training are designed to coordinate the muscles of breathing and the muscles in the voice box, resulting in the best voice with the least amount of effort.
This strength and conditioning through daily exercise is similar to physical therapy, though instead of lifting weights, you make sounds. One example is holding out “ah” at high pitches and low pitches to work the different muscles of the vocal cords/folds and larynx.
However it is not always so simple, as no one-size-fits-all program exists for every person experiencing age-related changes to the voice.
“It is important to work with a voice-specialized speech pathologist if you are diagnosed with presbyphonia because they can give you personalized insights on how to work with your voice and make improvements in a way that is sustainable,” Ms. Boddicker says.
In some patients, however, vocal coordination and strength training are not enough to restore the voice to acceptable levels. If vocal difficulties after attempted behavioral therapy continue to be a source of social withdrawal and significantly reduce the patient’s quality of life, then consideration should be given to surgical techniques to bulk up the vocal cords/folds.
Bulking up the vocal cords/folds through surgery, does not usually restore the voice completely, but usually increases the patient’s vocal volume and reduces their effort to produce that voice. This allows the patients to be heard so that they may continue to interact and remain social, says Mark Courey, MD, Professor of Otolaryngology-Head and Neck Surgery, and Director of the Grabscheid Voice and Swallowing Center.
The vocal cords/folds can be bulked up either by injecting fat or by implanting plastic or Gore-Tex strips beneath them to partially push them into a better position for talking so the patient does not need to work so hard.
Use It or Lose It
Perhaps the best approach to presbyphonia is a preventative one. Just as we exercise to keep our muscles strong and responsive, it is important to find opportunities to keep using our voices so that our larynx and vocal cords/folds do not weaken and make it difficult to speak. This can be challenging for older adults if there are fewer opportunities for daily interactions.
“Look for opportunities to increase your voice use through the day,” Ms. Boddicker says. “Read aloud to yourself, sing around the house for fun, call a couple of friends each day, or stay connected in your community. All these activities can help keep your voice more youthful.”
Ultimately, if you are experiencing any age-related voice changes that are making it hard to communicate or be heard, it is important to have an exam so that you know what is going on and can take action to protect and even restore a more youthful quality to your voice.
To make an appointment for your voice, call 212-241-9425 or email entpatientservices@mountsinai.org. For initial consults, you will need an appointment with both a laryngologist and a speech language pathologist.