Some remedies for older voices
Just as knees can become arthritic and heart muscles can weaken as we grow older, vocal cords too can feel the effects of aging -- and make it difficult for people to communicate.
As we age, our bodies tend to atrophy, and the same thing happens to the vocal cords, said Dr. Kenneth Altman, director of the Voice Center at Northwestern Memorial Hospital. Voices, which consist of a pair of vocal cords, are delicate instruments. At rest, the cords, located just above the windpipe, sit apart, allowing air to pass through for breathing. To produce sound, the cords move close together, leaving only a tiny passage for air to flow through, which makes them vibrate and creates the sound we recognize as the voice.
Vocal cords that have atrophied cannot close tightly, so they produce a weaker, breathier voice, making it difficult to be heard and understood.
Doris Dockery of Evans, Ga., was 64 when she started having trouble with her voice. She said it was so soft she had to write notes and even carried a sign that read, “I probably can’t make you hear me, but I hear you.” One of the most difficult things, she said, was not being able to talk to her children on the phone. She would have to pass notes to her husband when they called their sons. The inability to be heard can make people shun social contact and diminishes their quality of life. “They’re out of the communication loop,” said Dr. Clark Rosen, director of the University of Pittsburgh Voice Center. “It’s very, very isolating and defeating and frustrating to these people.”
For most voice problems, the first step after examination and diagnosis is voice therapy, which involves behavioral training and rehabilitation exercises to help patients speak more safely and efficiently. In most patients, “the exercises and muscle reconditioning are enough to establish a much more youthful, highly acceptable voice,” said Dr. Robert Sataloff, chairman of the otolaryngology department at the Graduate Hospital in Philadelphia. In addition to strengthening the structures that make up the voice, the therapy improves patients’ lung capacity and strengthens back, abdominal and chest muscles, all of which support the voice.
Those who depend on their voices for their livelihood, such as singers, teachers and radio announcers, are especially vulnerable. Leonard Kuntz, 80, of Pittsburgh started having trouble with his voice while he was still in his 20s. Before retiring in 1990, Kuntz taught urban geography at the University of Pittsburgh and eventually joined the school’s administration, partly to save his voice.
After struggling with hoarseness and vocal fatigue for years, he finally got help about 10 years ago when he was referred to Rosen. Kuntz learned that his vocal cords were so thin and bowed that voice therapy alone could not help him. Instead, Rosen recommended a procedure in which the vocal cords are injected with a biologically safe substance (such as fat from the patient’s body), which plumps up the cords and makes it easier for them to close.
Another invasive procedure often used to help the aging voice is medialization laryngoplasty, which uses surgical implants to correct bowing of the vocal cords or to strengthen weakened cords.
Medialization laryngoplasty requires a 1-inch incision in the neck over the larynx (also known as the voice box), at the lower part of the Adam’s apple. A tiny plastic implant is shaped by the surgeon and then gently inserted into the larynx next to one of the vocal cords, pushing it more toward the midline. The implant serves to reposition the vocal cords, enabling them to come closer together.
As our population ages, voice problems are bound to increase, and more people will suffer the frustration of being unable to communicate, experts said.
“Having a functional voice is important, particularly [because] people are living longer and the demands on their voices are much higher,” said Dr. Jacquelynne Corey, associate professor of surgery at the University of Chicago Hospitals.
