Vocal changes common during aging process

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Dear Doctors: My chorus has started meeting again — outdoors and vaccinated — to practice and sing. We’ve had a year off, and I’m upset that my voice is getting to be hoarse, and even cracking on low notes. I’m 67 years old and have always been a good singer. Is this happening from disuse?

Dear Reader: You’ve reached an age at which many adults begin to notice changes to the sound and timbre of their voices. This is often due to the physical effects of aging. They may affect the vocal apparatus directly, and can also arise from issues having to do with an individual’s general health, strength and fitness.

The specific changes that occur in the larynx, which is where the human voice originates, are known as presbylaryngis. In plainer language, it’s called vocal fold atrophy. The more general vocal changes that occur as someone grows older, including those due to vocal fold atrophy, go by the name of presbyphonia. This is also referred to as “aging voice.”

To better understand vocal cord atrophy, let’s start with the larynx, or voice box. It’s a tubular structure located in the neck, above the trachea, or windpipe, that plays a crucial role in breathing and swallowing. It also houses the vocal cords, or vocal folds. They are two bands of smooth muscle tissue, wrapped in a mucus-like covering, that stretch across the top of the windpipe. The vocal folds open to allow breathing and close while swallowing. This keeps the contents of the mouth from entering the lungs. When we make sound, the two vocal folds draw close together and form a slit. As air from the lungs is forced through the narrow slit, it creates suction that sets the mucus-like outer layer of the vocal folds to vibrating.

This mucosal wave generates the sounds that, shaped by muscular movements in and around the larynx, and after a complex journey through various structures and cavities in the neck and face, we recognize as voice. In order to produce a clear tone, the vocal folds must remain strong, moist and flexible, and they must be able to vibrate in symmetry.

But as people age, the larynx can become stiff, and the vocal folds can lose muscle tone, elasticity and moisture. This is known as vocal fold atrophy. It interferes with the precise actions and positioning of the vocal folds that are needed for clean and clear vocal tones. This can result in vocal tones that are thin, rough or hoarse, as well as the cracking voice that you’re experiencing. Age-related changes to the body, such as decreased lung capacity and loss of strength and muscle tone, can result in a voice that is high, thin, breathy, shaky or reedy. A loss of volume, as well as vocal fatigue, are also common. Because the onset of hoarseness can sometimes be a symptom of an underlying health condition, checking with your health care provider is a good idea.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu. Copyright 2021 UCLA Health

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