Aging and Voice - Med Speech Voice & Swallow Center

Aging and Voice - Med Speech Voice & Swallow Center

The Aging Voice Presented by Anastasia Serbalik Presented to Rebecca L. Gould, MSC, CCC-SLP Increasing need for Geriatric Otolaryngology During the 20th century the number of persons in the U.S. under 65 has tripled The number of people over 65 has increased by 11 times during the 20th century! By the year 2050 1/5 people will be 65 or

older Increasing need for Geriatric Otolaryngology Vocal disturbance is among one of the top medical complaints of the elderly An estimated 12% of the elderly have vocal dysfunction Aging: Changes in Respiratory

Support Decreased vital capacity-decrease by one liter for both males and females Loss of efficiency-loss of elasticity in thoracic skeleton, muscular weakness Reduction of loudness Aging: Changes in laryngeal mechanism Calcification and Ossification of laryngeal cartilages

Degeneration of laryngeal muscles Thickening of connective tissue of lamina propria Thinning of intermediate layer of lamina propria densening of deep layer of lamina propria Changes in Laryngeal Mechanism: Males & Females *In women vocal folds become more

edamatous and polyploidy *In men vocal folds become more thin and atrophied Aging: Changes in Laryngeal Mechanism Changes in the cricoarytenoid joint - pitch of voice is fine-tuned by control over position of arytenoid cartilage which may

account for pitch variability Restriction of vocal fold approximation Changes in Supralaryngeal Mechanism Atrophy of facial, pharyngeal, and mastication muscles Weakened esophageal sphincter may lead to gastro esophageal reflux Aging: Changes in

Supralaryngeal system Craniofacial enlargement by 3-5% Changes in articulators-loss of teeth, reduced musculature of tongue and masticular muscles affect resonation Functional Effects of Age

Related changes of the Voice After fifth decade of life increase in male fundamental frequency in males (35 Hz) Decrease in fundamental frequency of women (10-15 Hz) Increase in pitch perturbation cycle to cycle variation of fundamental frequency difficult to maintain a stable tone

Functional Effects of Age Related Changes of the Voice Reduced pitch range Decreased sound pressure level Vocal quality symptoms of vocal roughness, aperiodicity, breathiness Common Vocal Fold Findings in the Elderly Bowed cords

Atrophy Edema Loss of collagen, ground substance, and cartilage matrix in the cricoarytenioid joint Atrophy of laryngeal muscles Bowed Vocal Fold Most common benign pathology of the aging voice Gap occurs in the region of the middle onethird of the vocal cord with total or near approximation at anterior and posterior

commisures Atrophic Vocal Folds With advancing age the vocal fold muscle and mucosal covering can lose mass,

appearing as thinned Incomplete closure of vocal folds and irregular vibration Edema Swelling of the entire

layer of superficial lamina propria Water balloon effect Result in irregular mucosal wave The Aging Voice: The Challenge of Diagnosis Factors: 1. Identification of normal aging voice from pathological condition 2. Inappropriate/insufficient assessments

3. Incomplete/inaccurate Case history It is important to remember although vocal changes often occur with aging they occur in many other pathological states (Linville, 2004) Differential Diagnosis: Pathologic conditions vs. normal aging voice

Inflammatory and Autoimmune diseases Neoplasms-abnormal new mass of tissue serving no purpose (benign & malignant) can occur in larynx or thyroid Functional and psychogenic disorders of speech May be misconstrued as part of normal aging

Differential Diagnosis: Pathologic conditions vs. normal aging voice Essential tremor Parkinsons disease Stroke Myastehnia gravis Amyotrophic lateral sclerosis Differential Diagnosis:Aging voice vs. pathologic condition

HOARSENESS is both a quality frequently found in normal aging voice AND one of the most common symptoms of vocal dysfunctionso how do we differentiate malignant from benign etiologies of hoarseness Diagnosis of the Aging Voice:Useful tools

TIME is the most useful therapeutic measure that may help to distinguish benign from malignant etiologies of hoarseness REFERRAL to the otolaryngologist to perform a thorough laryngeal exam is an invaluable resource in diagnosis and management of hoarseness CASE HISTORY-elements of a patients history

and symptomology are gateways in forming appropriate diagnosis Differential diagnosis:Aging voice vs.. disordered voice Indicators hoarseness is NOT due to Benign changes Voice changes of recent onset Associated pain with phonation Pain or difficulty swallowing

Presence of new neck mass Past history of alcohol or tobacco use Diagnosis of the Aging Voice: Assessment Until recently Speech Pathologists had very little data to indicate the normal voice and speech patterns of the elderly TAKE A LOOK AT THIS..

The Aging Voice & Diagnosis 1998 Sinard & Hall reported there are no objective tests that can reliably distinguish voice changes due to normal aging process from disease of the larynx

1999 Whitlock reported the need for an acoustical test to accurately monitor potential voice disorders 2004 Verdonck-de Leeuw & Mahieu report a lack of longitudinal studies on the effects of aging on voice Diagnosis of the Aging Voice: Advancements in Assessment Recent longitudinal research study conducted by Verdonck-de Leeuw &

Mahieu used Multidimensional Voice Program to acoustically analyze eight parameters of voice by digitizing sustained vowels and fragments of speech Omnidirectional telephones Custom-made amplifiers DAT recorder Findings of Longitudinal Study on vocal aging and impact on daily life:

Significant deterioration of voice as soon as 5 years after age 50 Voice instability, changes in fundamnetal frequency Tendency to avoid social parties increase in isolating behaviors Male smokers with irreversible lower fundamental frequencies

(Veronck-de Leeuw & Mahieu, 2004) Findings of Longitudinal Study on vocal aging and impact on daily life THE LATEST NEWS: histological & genetic findings of recent studies give rise to a theory that aging will inevitably lead to a mild-moderate-severe voice impairment (Veronck-de Leeuw & Mahieu, 2004)

New Research: How voice gives away a persons age Researchers identified key indicators of the aging voice Used computer software to speed up and lower voices of older men to sound younger Results found 12/13 old voices were mistook as

young Implications Criminal forensics Hollywood, aging of actors voices (Ascribe Medicine News Service, 2003) Keeping the Voice Young

You are as young as you sound Eat sensibly Get plenty of rest Keep brain and voice well exercised Use the strong muscles of your lower abdominals to support voice Keep hydrated-8 a day

Be alert for voice damaging symptoms of GERD References Deem, M. & Miller, L. (2000). Manual of Voice Therapy. Austin, TX: PRO-ED, Inc. Linville, S. E. (2004, Oct.19) The Aging Voice. The ASHA Leader, p.12, 21

Shields, Gordon. (2004, June 16). Geriatric Otolaryngology Spotlight on Special Topics in Voice Disorders (2004) In The New York Eye and Ear Infirmary, Center for Voice. Retrieved June 10, 2005, from http://www.nyeee.edu/cfv-spotlight References

Ordonez, Ernesto A. (2000)Growth of anti-aging field offers new career option. A voice of experience p.16, I.12). Research uncovers How the voice gives away a persons age. (2003) Ascribe Medicine News Service. Sinard, R. & Hall, D. (1998). The aging voice:how to differentiate disease from normal changes. Geriatrics, p.76

References Verdonck-de Leeuw, Irma & Hans F. Mahieu (study. Journal of Voice 2004). Vocal aging and the impact on daily life: a longitudinal, 18, 193-203. 53. Whitlock, Kelly (1999). Age-Related Vocal Changes Often Misdiagnosed. Science Daily.

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