Aging Voice Importent

8/4/2019 Aging Voice Importent

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The Aging VoiceThe Aging Voice

Presented by Anastasia SerbalikPresented by Anastasia Serbalik

Presented to Rebecca L. Gould, MSC,Presented to Rebecca L. Gould, MSC,CCCCCC--SLPSLP


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Increasing need for GeriatricIncreasing need for Geriatric

OtolaryngologyOtolaryngology During the 20th century the number ofDuring the 20th century the number of

persons in the U.S. under 65 has tripledpersons in the U.S. under 65 has tripled

The number of people over 65 has increasedThe number of people over 65 has increasedby 11 times during the 20th century!by 11 times during the 20th century!

By the year 2050 1/5 people will be 65 orBy the year 2050 1/5 people will be 65 or

olderolder


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Increasing need for GeriatricIncreasing need for Geriatric

OtolaryngologyOtolaryngology Vocal disturbance is among one of the topVocal disturbance is among one of the top

medical complaints of the elderlymedical complaints of the elderly

An estimated 12% of the elderly have vocalAn estimated 12% of the elderly have vocaldysfunctiondysfunction


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Aging: Changes in RespiratoryAging: Changes in Respiratory

SupportSupport Decreased vital capacityDecreased vital capacity--decrease by onedecrease by one

liter for both males and femalesliter for both males and females

Loss of efficiencyLoss of efficiency--loss of elasticity inloss of elasticity inthoracic skeleton, muscular weaknessthoracic skeleton, muscular weakness

Reduction of loudnessReduction of loudness


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Aging: Changes in laryngealAging: Changes in laryngeal

mechanismmechanism Calcification and Ossification of laryngealCalcification and Ossification of laryngeal

cartilagescartilages

Degeneration of laryngeal musclesDegeneration of laryngeal muscles Thickening of connective tissue of laminaThickening of connective tissue of lamina

propriapropria

Thinning of intermediate layer of laminaThinning of intermediate layer of laminapropriapropria

densening of deep layer of laminadensening of deep layer of laminapropriapropria


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Changes in LaryngealChanges in Laryngeal

Mechanism: Males & FemalesMechanism: Males & Females

*In women vocal folds

become more edamatousand polyploidy

*In men vocal folds becomemore thin and atrophied


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Aging: Changes in LaryngealAging: Changes in Laryngeal

MechanismMechanism Changes in the cricoarytenoid jointChanges in the cricoarytenoid joint

-- pitch of voice is finepitch of voice is fine--tuned by control overtuned by control over

position of arytenoid cartilage which mayposition of arytenoid cartilage which mayaccount for pitch variabilityaccount for pitch variability

Restriction of vocal fold approximationRestriction of vocal fold approximation


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Changes in SupralaryngealChanges in Supralaryngeal

MechanismMechanism Atrophy of facial, pharyngeal, andAtrophy of facial, pharyngeal, and

mastication musclesmastication muscles

Weakened esophageal sphincter may lead toWeakened esophageal sphincter may lead togastro esophageal refluxgastro esophageal reflux


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Aging: Changes inAging: Changes in

Supralaryngeal systemSupralaryngeal system Craniofacial enlargement by 3Craniofacial enlargement by 3--5%5%

Changes in articulatorsChanges in articulators--loss of teeth,loss of teeth,

reduced musculature of tongue andreduced musculature of tongue and

masticular muscles affect resonationmasticular muscles affect resonation


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Functional Effects of AgeFunctional Effects of Age

Related changes of the VoiceRelated changes of the Voice After fifth decade of life increase in maleAfter fifth decade of life increase in male

fundamental frequency in males (35 Hz)fundamental frequency in males (35 Hz)

Decrease in fundamental frequency of womenDecrease in fundamental frequency of women(10(10--15 Hz)15 Hz)

Increase in pitch perturbation cycle to cycleIncrease in pitch perturbation cycle to cyclevariation of fundamental frequencyvariation of fundamental frequency

difficult to maintain a stable tonedifficult to maintain a stable tone


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Functional Effects of AgeFunctional Effects of Age

Related Changes of the VoiceRelated Changes of the Voice

Reduced pitch rangeReduced pitch range

Decreased sound pressure levelDecreased sound pressure level

Vocal quality symptoms of vocalVocal quality symptoms of vocal

roughness, aperiodicity, breathinessroughness, aperiodicity, breathiness


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Common Vocal Fold FindingsCommon Vocal Fold Findings

in the Elderlyin the Elderly

Bowed cordsBowed cords

AtrophyAtrophy

EdemaEdema

Loss of collagen, ground substance, andLoss of collagen, ground substance, and

cartilage matrix in the cricoarytenioid jointcartilage matrix in the cricoarytenioid joint

Atrophy of laryngeal musclesAtrophy of laryngeal muscles


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Bowed Vocal FoldBowed Vocal Fold

Most common benign pathology of theMost common benign pathology of the

aging voiceaging voice

Gap occurs in the region of the middle oneGap occurs in the region of the middle one--third of the vocal cord with total or nearthird of the vocal cord with total or near

approximation at anterior and posteriorapproximation at anterior and posterior

commisurescommisures


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Atrophic Vocal FoldsAtrophic Vocal Folds

With advancing ageWith advancing age

the vocal fold musclethe vocal fold muscle

and mucosal coveringand mucosal covering

can lose mass,can lose mass,

appearing as thinnedappearing as thinned

Incomplete closure ofIncomplete closure of

vocal folds andvocal folds andirregular vibrationirregular vibration


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EdemaEdema

Swelling of the entireSwelling of the entire

layer of superficiallayer of superficial

lamina proprialamina propria

Water balloon effectWater balloon effect

Result in irregularResult in irregular

mucosal wavemucosal wave


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The Aging Voice: TheThe Aging Voice: The

Challenge of DiagnosisChallenge of Diagnosis

Factors:

1. Identification of normal aging voice

from pathological condition

2. Inappropriate/insufficient assessments

3. Incomplete/inaccurate Case history


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It is important to remember

It is important to rememberalthough vocal changes oftenalthough vocal changes often

occur with aging they occur inoccur with aging they occur in

many other pathological statesmany other pathological states

(Linville, 2004)(Linville, 2004)


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Differential Diagnosis:Differential Diagnosis:

Pathologic conditions vs.Pathologic conditions vs.

normal aging voicenormal aging voice

Inflammatory and Autoimmune diseasesInflammatory and Autoimmune diseases

NeoplasmsNeoplasms--abnormal new mass of tissue servingabnormal new mass of tissue servingno purpose (benign & malignant) can occur inno purpose (benign & malignant) can occur in

larynx or thyroidlarynx or thyroid

Functional and psychogenic disorders of speechFunctional and psychogenic disorders of speech

May be misconstrued as part of normal agingMay be misconstrued as part of normal aging


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Differential Diagnosis:Differential Diagnosis:

Pathologic conditions vs.Pathologic conditions vs.

normal aging voicenormal aging voice

Essential tremorEssential tremor

Parkinsons diseaseParkinsons disease

StrokeStroke

Myastehnia gravisMyastehnia gravis

Amyotrophic lateral sclerosisAmyotrophic lateral sclerosis


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Differential Diagnosis:AgingDifferential Diagnosis:Aging

voice vs. pathologic conditionvoice vs. pathologic condition HOARSENESS is both a quality frequentlyHOARSENESS is both a quality frequently

found in normal aging voice AND one offound in normal aging voice AND one of

the most common symptoms of vocalthe most common symptoms of vocaldysfunctionso how do we differentiatedysfunctionso how do we differentiate

malignant from benign etiologies ofmalignant from benign etiologies of

hoarsenesshoarseness


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Diagnosis of theDiagnosis of the

Aging Voice:Useful toolsAging Voice:Useful tools TIMETIME is the most useful therapeuticis the most useful therapeutic

measure that may help to distinguish benign frommeasure that may help to distinguish benign frommalignant etiologies of hoarsenessmalignant etiologies of hoarseness

REFERRALREFERRAL to the otolaryngologist to perform ato the otolaryngologist to perform athorough laryngeal exam is an invaluable resourcethorough laryngeal exam is an invaluable resourcein diagnosis and management of hoarsenessin diagnosis and management of hoarseness

CASE HISTORYCASE HISTORY--elements of a patients historyelements of a patients historyand symptomology are gateways in formingand symptomology are gateways in formingappropriate diagnosisappropriate diagnosis


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Differential diagnosis:AgingDifferential diagnosis:Aging

voice vs.. disordered voicevoice vs.. disordered voice

Indicators hoarseness is NOT due to BenignIndicators hoarseness is NOT due to Benign

changeschanges Voice changes of recent onsetVoice changes of recent onset

Associated pain with phonationAssociated pain with phonation

Pain or difficulty swallowingPain or difficulty swallowing

Presence of new neck massPresence of new neck mass

Past history of alcohol or tobacco usePast history of alcohol or tobacco use


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Diagnosis of the Aging Voice:Diagnosis of the Aging Voice:

AssessmentAssessment Until recently Speech Pathologists had veryUntil recently Speech Pathologists had very

little data to indicate the normal voice andlittle data to indicate the normal voice and

speech patterns of the elderlyspeech patterns of the elderly

TAKE A LOOK AT THIS..TAKE A LOOK AT THIS..


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The Aging Voice & DiagnosisThe Aging Voice & Diagnosis

19981998 Sinard & Hall reported there are noSinard & Hall reported there are no

objective tests that can reliably distinguish voiceobjective tests that can reliably distinguish voice

changes due to normal aging process from diseasechanges due to normal aging process from disease

of the larynxof the larynx

19991999 Whitlock reported the need for an acousticalWhitlock reported the need for an acoustical

test to accurately monitor potential voice disorderstest to accurately monitor potential voice disorders

20042004 VerdonckVerdonck--de Leeuw & Mahieu report a lackde Leeuw & Mahieu report a lackof longitudinal studies on the effects of aging onof longitudinal studies on the effects of aging on

voicevoice


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Diagnosis of the Aging Voice:Diagnosis of the Aging Voice:

Advancements in AssessmentAdvancements in Assessment Recent longitudinal research studyRecent longitudinal research study

conducted by Verdonckconducted by Verdonck--de Leeuw &de Leeuw &Mahieu used Multidimensional VoiceMahieu used Multidimensional VoiceProgram to acoustically analyze eightProgram to acoustically analyze eightparameters of voice by digitizing sustainedparameters of voice by digitizing sustainedvowels and fragments of speechvowels and fragments of speech

Omnidirectional telephonesOmnidirectional telephones CustomCustom--made amplifiersmade amplifiers

DAT recorderDAT recorder


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Findings of Longitudinal StudyFindings of Longitudinal Study

on vocal aging and impact onon vocal aging and impact on

daily life:daily life:

Significant deterioration of voice as soon as 5Significant deterioration of voice as soon as 5years after age 50years after age 50

Voice instability, changes in fundamnetalVoice instability, changes in fundamnetalfrequencyfrequency

Tendency to avoid social parties increase inTendency to avoid social parties increase inisolating behaviorsisolating behaviors

Male smokers with irreversible lower fundamentalMale smokers with irreversible lower fundamentalfrequenciesfrequencies

(V

eronck-de Leeuw & Mahieu, 2004)


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Findings of Longitudinal StudyFindings of Longitudinal Study

on vocal aging and impact onon vocal aging and impact on

daily lifedaily life

THE LATEST NEWS: histological &THE LATEST NEWS: histological &

genetic findings of recent studies give risegenetic findings of recent studies give riseto a theory that aging will inevitably lead toto a theory that aging will inevitably lead to

a milda mild--moderatemoderate--severe voice impairmentsevere voice impairment

(V

eronck-de Leeuw & Mahieu, 2004)


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New Research: How voice givesNew Research: How voice gives

away a persons ageaway a persons age

Researchers identified key indicators of the agingResearchers identified key indicators of the agingvoicevoice

Used computer software to speed up and lowerUsed computer software to speed up and lowervoices of older men to sound youngervoices of older men to sound younger

Results found 12/13 old voices were mistook asResults found 12/13 old voices were mistook asyoungyoung

ImplicationsImplications

Criminal forensicsCriminal forensics

Hollywood, aging of actors voicesHollywood, aging of actors voices(Ascribe Medicine News Service,(Ascribe Medicine News Service,

2003)2003)


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Keeping the Voice YoungKeeping the Voice Young

You are as young as you soundYou are as young as you sound

Eat sensiblyEat sensibly

Get plenty of restGet plenty of rest Keep brain and voice well exercisedKeep brain and voice well exercised

Use the strong muscles of your lower abdominalsUse the strong muscles of your lower abdominals

to support voiceto support voice

Keep hydratedKeep hydrated--8 a day8 a day

Be alert for voice damaging symptoms of GERDBe alert for voice damaging symptoms of GERD


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ReferencesReferences

Deem, M. & Miller, L. (2000).Deem, M. & Miller, L. (2000).Manual of VoiceManual of VoiceTherapy.Therapy. Austin, TX: PROAustin, TX: PRO--ED, IncED, Inc..

Linville, S. E. (2004, Oct.19) The Aging Voice.Linville, S. E. (2004, Oct.19) The Aging Voice.

The ASHA LeaderThe ASHA Leader, p.12, 21, p.12, 21

Shields, Gordon. (2004, June 16). GeriatricShields, Gordon. (2004, June 16). GeriatricOtolaryngologyOtolaryngology

Spotlight on Special Topics in Voice DisordersSpotlight on Special Topics in Voice Disorders(2004)(2004) In The New York Eye and EarInfirmary,In The New York Eye and EarInfirmary,Center forVoice. Retrieved June 10, 2005, fromCenter forVoice. Retrieved June 10, 2005, fromhttp://www.nyeee.edu/cfvhttp://www.nyeee.edu/cfv--spotlightspotlight


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Ordonez, Ernesto A. (2000)Growth of antiOrdonez, Ernesto A. (2000)Growth of anti--agingaging

field offers new career option. A voice offield offers new career option. A voice of

experience p.16, I.12).experience p.16, I.12).

Research uncovers How the voice gives away aResearch uncovers How the voice gives away a

persons age. (2003) Ascribe Medicine Newspersons age. (2003) Ascribe Medicine News

Service.Service.

Sinard, R. & Hall, D. (1998). The agingSinard, R. & Hall, D. (1998). The agingvoice:how to differentiate disease from normalvoice:how to differentiate disease from normal

changes.changes. Geriatrics,Geriatrics,p.76p.76


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VerdonckVerdonck--de Leeuw, Irma & Hans F.de Leeuw, Irma & Hans F.Mahieu (study.Mahieu (study. Journal of VoiceJournal of Voice 2004).2004).Vocal aging and the impact on daily life: aVocal aging and the impact on daily life: alongitudinal, 18, 193longitudinal, 18, 193--203. 53.203. 53.

Whitlock, Kelly (1999). AgeWhitlock, Kelly (1999). Age--Related VocalRelated VocalChanges Often Misdiagnosed.Changes Often Misdiagnosed. ScienceScience

Daily.Daily.

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Aging Voice Importent