“Once you turn 60, it all goes down from there,” one of my patients told me. She had always been healthy without any medical problems, an active senior who took care of her grandchildren during the day. It seemed almost overnight after turning 60, she inherited 3 medications for high cholesterol, high blood pressure, and arthritis. She also noticed that she was getting hoarse during choir and was having trouble singing with her grandchildren. “Dr. CP, what happened to my voice?” She asked me.
Unfortunately, the aging process affects all parts of our body, including our voice. As we age, our lung function decreases as the chest muscles weaken and have less elastic recoil. The nerves of the larynx (voice box, pronounced “lar-inks”) also can weaken, making it harder to manipulate the voice. Even the glands in our mouth and throat can have problems, leading to dry mouth with thickened mucous, which also negatively impacts the voice. The vocal folds (aka vocal cords) may weaken over time, leading to a bowed appearance to the otherwise straight vocal folds, thus called “vocal fold bowing.” When the vocal folds are weak, they have trouble coming together to vibrate, leading to a quiet and hoarse voice. But not all hoarseness in an older person is due to vocal fold bowing. A thorough workup that includes a good view of the larynx using a flexible or rigid telescope should be done in the office by an ENT (Ear-Nose-Throat Surgeon, Otolaryngologist or Laryngologist) that specializes in voice to make sure there are no other causes of hoarseness including laryngeal lesions, medical problems like reflux and allergies, and functional problems such as immobility of the vocal folds.
The good news is that most vocal problems due to aging can be treated primarily with voice therapy by a speech language pathologist (SLP). Continued problems despite voice therapy may be improved with in-office procedures and surgery.
by Esther J. Cheung-Phillips, MD
