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The Aging Voice and Differentiating Diseases Laurie Kozlakowski.

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1 The Aging Voice and Differentiating Diseases Laurie Kozlakowski

2 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

3 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 -loss of vocal fold mass  decrease patients ability to bring the vocal folds together- weak, breathy voice

4 Young vs. Aged vocal folds  Young (healthy)  Aged

5 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

6 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”

7 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 EpitheliumThickening Progressive in males until 70, declines thereafter Progressive in females after 70 From Linville, Vocal Aging

8 Perceptual Age-related changes MaleFemale Determine age from voice sample XX Classify into age groups XX Pitch changes XX Hoarseness XX Breathy XX Slow rate XX

9 Physiologic Age-related changes MaleFemale Vital capacities SmallerSmaller Lung pressures LowerLower Peak airflow rates Greater Leakage airflow rates Greater

10 Acoustic Age-related changes MaleFemale Avg Fund Freq HigherLower Fo variability GreaterGreater Freq Pertubation GreaterGreater Fo range SmallerSmaller Avg Intensity level SmallerSmaller Variability of Intensity SmallerSmaller Intensity range SmallerSmaller Speaking rate SlowerSlower

11 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

12 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

13 Normal vs. Cancerous  Normal  Cancer (beginning stage)

14 Early and Advanced Signs of Cancer Location of primary tumour Early Disease Advanced Disease Supraglottic Disturbance of Swallowing Hoarseness, dysphagia GlotticHoarseness Airway obstruction Subglottic Mild haemoptysis Hoarseness, airway obstruction

15 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

16 Treatment Options for the Aging Voice  Surgery –Thyroplasty –Injection –Surgical correction  Voice Therapy

17 Voice therapy should focus on… 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

18 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

19 References  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,  Sataloff, R, Rosen, D., Hawkshaw, M., & Spiegel, J. (1997). The aging adult voice. Journal of Voice,  Sinard, R. & Hall, D. (1998). The aging voice: How to differentiate disease from normal changes. Geriatrics, 53(7),   l l l

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