Management of the Aging Voice

Other medical conditions commonly found in older persons and that can affect the voice include hormonal changes, tumors, viruses, allergies, and gastroesophageal reflux disease (GERD).

Accurate diagnosis of the cause of vocal problems in the elderly is therefore the first critical step. Along with a thorough medical history, which includes medications and environmental factors (e.g., tobacco smoke) that can affect the voice, examination of the larynx to look at the vocal cords and to determine the degree of glottal incompetence is critical.

If an underlying medical condition is found, treatment of the condition is the next step. Simple measures such as better hydration or controlling the inflammatory changes associated with GERD or persistent posterior nasal drainage may be of help to many elderly patients with vocal changes, according to Dr. Shapshay.

For patients whose vocal changes are identified as presbyphonia, different therapeutic options are available, depending on the degree of vocal fold changes as well as the needs of the patient.

Treatment Options for Presbyphonia

Voice Therapy

The first and, for most patients, the only treatment needed for voice alterations due to the aging larynx will be voice therapy. Voice therapy is a common first treatment, said Nadine P. Connor, PhD, a speech pathologist and Assistant Professor at the University of Wisconsin in the Departments of Communicative Disorders and Surgery. The pro of voice therapy is that it is noninvasive; the con is that it can take time and home practice and the patient has to be cognitively able and motivated to perform the exercises.

As the third step in what Dr. Sataloff has termed voice lift therapy (the first two steps being a comprehensive evaluation and treatment of any identified medical condition), voice therapy includes techniques and exercises to restrengthen the power source of the voice, which includes medically supervised aerobic retraining of the respiratory, abdominal, and back muscle systems. In Dr. Sataloff’s practice, along with a speech pathologist, most patients also see a singing voice specialist even if they are not singers, and some eventually also see an acting voice specialist as well. Using singing training for a speaker is like using jogging or running for someone who wants to walk better, he said. It gives them training beyond anything they’ll need for daily speech, so even when they are talking in public they are nowhere near the limits of their ability.

According to Dr. Benninger, although compliance can be low, as it is for therapy for any chronic medical condition, he emphasized that for people who really need their voices, compliance is fairly good. In general, most people can be helped in six to eight sessions, but they may have to continue exercises on their own to maintain vocal quality. Although factors that influence compliance or adherence to treatment have not been well studied for voice therapy, said Dr. Connor, studies are currently under way to examine these factors and their contribution to the success of voice therapy.