With aging, many people experience changes with their body. While most think of more wrinkles and more weakness in the overall body mass and tone, one’s voice may also encounter similar changes.

With the overall population living for longer durations, it is common for many adults to experience age-related voice changes. Some changes include a variation in pitch in which their voice has gotten higher or lower throughout the years, variations in volume, and overall changes with vocal quality.

Have you noticed any changes with either yourself or a loved one? If so, they may have presbyphonia and may benefit from a comprehensive evaluation from a speech-language pathologist.

What is Presbyphonia?

Presbyphonia, otherwise referred to as the aging voice or presbylarynx, is the age-related changes to one’s voice.

Many adults with presbyphonia report difficulty with volume, breath support, hoarseness, fatigue, and overall increased vocal effort to communicate with those around them.

While presbyphonia is due to age-related changes, the impact is multifactorial as it can create changes in the voice box, respiratory system, and neurological system.

Respiratory Changes and Presbyphonia

Aging individuals experience changes in the respiratory strength, endurance, and capacity for voicing. Some of these changes include:

  • Chest wall becomes more rigid making expansion and contraction of lungs more difficulty for voicing.
  • The alveoli structurally alter into “dead space” making decreased ability to “capture” oxygen creating more difficulty with deep breaths and lung capacity
  • Age related changes can also extend to one’s ability to cough

Voice Box and Presbyphonia

Aging individuals experience changes in their vocal folds and voice box that impact communication.

  • Similar to other parts of the body, individuals experience atrophy of muscles.
  • Decreased muscle strength and thinning of fibers

Neurological Changes and Presbyphonia

With age, individuals also experience changes to their neurological system that impact the sending of messages from the brain to the muscles.

  • Loss of motor units
  • Slowing of messages from the brain to muscles 

The structural changes can largely impact how one perceives their voice thus decreasing their overall quality of life. 

Impact of Presbyphonia

Presbyphonia can be debilitating and frustrating for many individuals as they try to navigate ways to improve communication. It can impact one’s ability to socialize with others and one’s ability to complete their workplace duties.

Some symptoms of presbyphonia include: 

  • Changes in Pitch- Women often experience a decrease in pitch while men experience an increase in pitch
  • Changes in Volume- Most individuals report a loss of vocal loudness as others around them may have difficulty hearing their voice. 
  • Changes in Vocal Quality- While vocal quality can largely vary, most individuals report a roughness and gravely quality. 
  • Changes in Vocal Effort- Most individauls report more effort to maintain the same duration of vocal use as before. One might complain of being out of breath when talking with others or having a decrease in volume with more vocal use.

How is Presbyphonia Diagnosed?

Presbyphonia is typically diagnosed by a physician with either laryngoscopy or videostroboscopy.

With presbyhonia, you would expect to see normal mobility of the vocal folds with adequate vibration. However, you may notice a bowing of the vocal folds or a glottal gap between the vocal folds as they are insufficiently able to close.

When vocal folds are unable to adequately close together, this makes it difficult for one to control the air flow from the lungs for voicing. As a result, air flow is often “wasted” and individuals are forced to use more vocal effort and breaths to communicate a message.  

Presbyphonia Treatment: Voice Therapy

While there are different treatment options for presbyphonia, voice therapy is the least invasive and most conservative approach. 

In voice therapy, an individual with presbyphonia would receive a comprehensive evaluation to determine areas of weakness and strength for voicing and any questions or concerns that the client may have. 

After the evaluation is completed, the speech-language pathologist would collaborate with the client in formulating voice therapy goals to determine which areas to focus on. Typically, voice therapy takes a global approach by addressing each system involved. The systems include the:

  • Respiratory System
  • Phonatory System
  • Articulatory System
  • Resonatory System

Research suggests that individuals who undergo voice therapy experience an increased functional voice status and overall improvement.

Studies also found that while some individuals prefer to take a “wait and see approach”, this can result in no improvement or possibly worse performance. 

Other treatment options include injection augmentation, bilateral thyroplasty, and medications. While the other treatment modalities receive success with improving vocal function, there are also risks with these more invasive procedures compared to voice therapy with a speech-language pathologist. 

When To Get Help

If you or a loved one notice a change in your voice, it is recommended that you see your primary care physician or a speech-language pathologist so you can determine what your treatment options are.

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