It’s an image-driven world in which we live. Instagram, Facebook, SnapChat, Twitter and YouTube launch llamas and two-toned dresses into stardom. We are also definitely not interested in showing our age. Botox and cosmetic surgeries work wonders for our outward appearance. But what is a person to expect as the larynx ages? Is a voice lift out of the plausible realm?
Some presbyphonia is present in many clients I see. As the male vocal folds lose mass, they bow outward and voice quality becomes breathy and high-pitched. The voice becomes lower in pitch as the female ages. This happens because muscle fibers do not regenerate as quickly when we get older, so the vocal folds begin to atrophy. The lamina propria (second layer of the vocal folds) is not as flexible and fibers tend to break down.
Three subsystems of the voice need to be in balance to have a fully functioning mechanism: breath, sound and resonance. When we age, lung tissues lose elasticity and rib-cage cartilages begin to ossify. Ossification also affects cartilages of the larynx. This is not always bad, as vocal scientist Ingo Titze suggests, because this hardening can help stabilize the voice box as it anchors the acrobatic muscles for speech or singing. A thoughtful article by Claudia Friedlander discusses this in further detail, as does this post from Gray Matter Therapy.
It’s helpful to think about our voices and how they differ because of gender. The female voice is affected by androgens, estrogen and progesterone. Wendy D. LeBorgne and Marci Rosenberg report in their book, “The Vocal Athlete,” that during menopause, low levels of estrogen cause the once thick mucosal membrane of the vocal folds to lose mass and flexibility. Progesterone has been shown to help shed cells off the vocal fold mucus membranes. Prior to menstruation, secretions and mucus on the vocal folds thicken, the larynx dries out, the voice becomes less agile and range may be affected. Hemorrhage risk and swelling is great at this time because capillaries change how they transport blood. Robert Sataloff has said in a NATS Chat recently, that the vocal fold swelling is protein-bound and cannot be shed by diuretics.
All of this happens because hormones are running rampant. A cure? Possibly regulation by birth-control medications, because they balance out those hormones. As menopause hits, hormones tend to disappear, and with them the qualities that made the voice sound female in the first place. Vocal folds thicken, epithelium atrophies, vocal fold nerve connections demyelinate. This might explain why vibrato slows as well.
What about the men? They start off with high-pitched voices, but when change occurs at puberty, pitch lowers with the presence of androgens. Booming male voices are the result of increased blood flow to the voice box. As with women, male hormones decrease with age, so power and tone go with them.
Presbylaryngis is an age-related voice issue caused by nature taking its course, but that doesn’t mean it can’t adversely affect quality of life. Voice pathologists do their best to rehabilitate with vocal function exercises and other treatment techniques. Sataloff says that 80 percent of the time this is sufficient. A surgical option is injection laryngoplasty, often coined the “voice lift.” The procedure consists of fat grafting, injectables or implants, and its necessity is controversial. Do people really need a rejuvenated voice? With an increase in hearing loss as we age, I can see why it’s popular.
Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She provides voice, swallowing and speech treatment in her private practice, a tempo Voice Center, LLC, and lectures on the singing voice to area choirs and students. She is an affiliate of ASHA Special Interest Group 3, Voice and Voice Disorders. Knickerbocker blogs on her website at www.atempovoicecenter.com. Follow her on Twitter @atempovoice or like her on Facebook at www.facebook.com/atempovoicecenter.