What are age-related voice changes? 

The larynx and vocal folds age along with the rest of the body. Aging affects two main aspects of vocal fold anatomy and function. First of all, the muscle of the vocal fold loses bulk (a process called “atrophy”), much like muscle elsewhere in the body. Second, the flexible tissues which are responsible for vocal fold vibration during voicing (known as the superficial lamina propria; click here for more information) become thinner, stiffer and less pliable. Together, these changes sometimes result in a voice which is perceived as sounding “old.”

Changes related to age vary a great deal from person to person, both in severity and time of onset. Some individuals may retain a resonant, normal-sounding voice deep into their 80s, whereas others begin to sound “old” as early as their 50s. We do not know what accounts for this variation. It is possible that some of it is genetically determined, and accounts for patterns of vocal aging that run in families.

Age-related voice change is one of the most intriguing topics in voice medicine, and a lot of research must still be performed before this phenomenon is fully understood. The reader should keep in mind that much of what follows remains a topic of active discussion and debate among physicians in this field.


What are the symptoms of age-related voice changes?

In general, a high-pitched, reedy roughness in the voice is considered characteristic of advanced age. There may also be a loss of projection and resonance, most evident when a person tries to be heard over background noise or from one room to another in a house.


What do age-related vocal fold changes look like?

Under normal circumstances, the edge of the vocal fold stretches in a straight line between its attachments to cartilage in the front and back of the larynx. Atrophy of the vocal fold muscle and thinning of the superficial vibratory tissues generally causes the edge to take on a scalloped appearance.

It is probably most prudent to begin treatment of age-related voice changes with a course of voice therapy. Mild changes may be overcome with improved voicing technique and some deliberate but not inconvenient effort on the part of the patient.

Some years ago, certain physicians introduced the idea of a “voice lift” – a surgical procedure to rejuvenate the voice similar in concept to a face lift. In fact, this was nothing more than vocal fold injection, a procedure which had been used for other problems like vocal fold paralysis for more than fifty years. The “voice lift” is more of a marketing maneuver than a medical breakthrough. In addition, the notion of “voice lift” suggests that remedying a voice problem is basically a cosmetic procedure, an idea that remains hotly debated today, not least because it has practical implications for health insurance coverage.