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

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

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
Epithelium
Thickening
Progressive in males until 70, declines thereafter
Progressive in females after 70
From Linville, Vocal Aging

8. Perceptual Age-related changes
Male
Female
Determine age from voice sample X
Classify into age groups
Pitch changes
Hoarseness
Breathy
Slow rate

9. Physiologic Age-related changes
Male
Female
Vital capacities
Smaller
Lung pressures
Lower
Peak airflow rates
Greater
Leakage airflow rates

10. Acoustic Age-related changes
Male
Female
Avg Fund Freq
Higher
Lower
Fo variability
Greater
Freq Pertubation
Fo range
Smaller
Avg Intensity level
Variability of Intensity
Intensity range
Speaking rate
Slower

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
Glottic
Hoarseness
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…
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),