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December 16, 2015

Infrequently Asked Questions: Why does our voice change as we age?

The world is full of questions we all want answers to but are either too embarrassed, time-crunched or intimidated to actually ask. In the spirit of that shared experience, we've embarked on a journey to answer all of the questions that burn in the minds of Philadelphians -- everything from universal curiosities (Why do disposable coffee cups still leak?) to Philly-specific musings (How does one clean the Liberty Bell?). 

No, vocal changes aren't just for puberty.

We've all had encounters with those folks who look like they've bathed scalp-deep in the Fountain of Youth, until they speak. Suddenly, their voice gives away that they were no stranger to the Summer of Love or the disco craze. And while it's well known that hormones are the culprit of vocal changes leading into adolescence, what's the deal when you hit your 40s, 50s and beyond?

We reached out to Dr. Joseph R. Spiegel, co-director of the Voice and Swallowing Center at Thomas Jefferson University Hospital, for an explanation.

Why does your voice change as you age?

There are three basic factors, but by far the most important is as we get older we tend to shrink a little bit and lose muscle mass, and that’s why people get a little shorter and get a little slighter. The vocal folds are made up of muscle with mucosal covering, and so as you lose a little bit of muscle bulk in your vocal cords, they're so small to begin with that they’re sensitive to that. So the architecture of your vocal cords changes for many of us as we get older and the voice changes. For many of us, it gets a little bit weaker, gruffer and can have some tonal changes, too. 

Another thing that's common is we can have drying as we get older -- a lot of medications cause drying as a side effect. That affects voice. And there are hormonal changes that women more than men go through that affect both sexes. That can change the voice with age as well.

Is there a reason a voice starts to crack or squeak?

The vocal cords vibrate when we speak; the way the voice is made is that we blow air out from our lungs and close the vocal cords over that column of air and it makes the vocal cords vibrate. So, as the vocal cords change, the bulk changes and the resistance to the air changes and changes vibratory pattern. And that changes the voice. What happens is we have trouble -- the voice wants to get deeper, but as we try to use more effort there can be an abnormally high-pitched voice. That’s what you’ll see in a lot of men: As they get older and try to get loud, they get this abnormal high-pitched voice because they’re squeezing the air out through a hole they can’t control. And that's all a whistle is, is blowing air across a small hole. If you can’t close your vocal cords all the way because you lose the muscle bulk but you want to try real hard and get your voice loud, you end up getting this squeakier, higher-pitched voice. Sometimes, men, they deal with it, and some men just get more quiet because they don’t like that sound as they’re trying to get louder.

Is it possible to alter your voice to sound younger? A vocal plastic surgery of sorts?

Absolutely. There’s a program we have, and we’re not the only people around who’ve developed this, that starts with speech therapy. These muscles can be reworked and built up again. I always use the analogy that elderly people can be muscle-builders and go to the gym and be muscular, they just have to do it differently and have to do multiple repetitions with small amounts of weight and smaller stresses because of what their bones can tolerate and the way their muscles are built. So, the 85-year-old is going to build their body more by walking around doing multiple reps with two- and five-pound weights than try to bench-press a 150-pound weight. Same thing with the voice. There's a number of techniques, and there’s been a couple things recently where speech pathologists have been very successful if patients are willing and cooperative to go through voice exercises and then do them themselves every day. And by far, the majority of our patients are fixed just with that. You know, many people, as they get older, they just stop talking. So if people lose their spouse, move away from family, are not living with their nuclear family and are in assisted living, they may not be talking to people as much as they did before or when they were working. It's atrophy, not using it as much. ... If they read a newspaper every day for a half hour, read it out loud and sit in a room and do it the right way and get advice from a speech pathologist on how to use their voice -- just to use your voice, that's a big part of the program.

Beyond that, we have an injectable substance we can inject in the vocal cords [under anesthesia] that replaces the bulk of the muscle that’s been lost; that’s been effective. And there’s an operation we do where we make a small hole in the voice box from the outside through a small incision and implant an implant that pushes the vocal folds back into their more normal position.

So we take people through a cascade of seeing how they’ll respond to voice therapy, and a majority respond well enough to that that we can just follow them and they’re doing better. And if that's not enough we can move on to these other procedures to help them.

Is there a different reason why singers' voices change with age? Some crack more, or others get raspier.

There’s lots of factors with that. There are singers who’ve at least partly been abusive to their voice through their career because their voice is a raspy sound or airy sound. You can look at the lead singer for Aerosmith who made a career out of a raspy, higher-pitched voice. That might be more abusive to the voice and might not do as well for upholding a long career. But it was certainly very successful for him and what he was doing at the time he was most popular. And also there’s a variability from patient to patient – I heard Tony Bennett on TV the other night and he has an incredible voice. He’s held onto it. And a big part of it is how active he’s kept himself, so it’s like any other athlete – that same guy who’s still running two miles a day at 85, he might not be able to run a marathon but, he’s part of the 1 percent of 85-year-olds who could run 10 miles if he wanted to.

If you’re lucky to begin with, and you keep up with it and keep yourself well exercised and health, you can hold onto your voice for a very long time.

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