Voice changes or voice loss are usually a part of the ageing process. Elderly persons usually complain that their throat is giving them trouble. Their voice becomes hoarse or inaudible over the years.
Vocal folds (pair of muscle bands in the larynx that help produce sound, also called vocal cords) have to close properly and vibrate so that voice comes out effectively.
As one grows older, the vocal cord muscles lose mass and weaken, so that they do not close completely, resulting in the voice becoming feeble or hoarse. Elderly people may also feel that they have to put more effort and strain to talk.
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In some instances, voice loss or hoarseness can be an indication of a serious condition affecting the voice box and vocal cords. Not being able to vocalise can also have a psychological impact on senior citizens as it leads to isolation and causes depression.
“Usually, when we speak or vocalise, the vocal cords meet in the midline without any gap,” Dr Debasish Datta Majumder, consultant, ENT, Manipal Hospitals, Varthur, Bengaluru, tells Happiest Health. “As people get older, this process gets weakened and a gap develops in between the vocal cords called the ‘phonatory’ gap. There is airflow between the vocal cords, which causes huskiness of voice. If any elderly person presents with hoarseness of voice, we also need to rule out any significant pathology in the vocal cords. We see many malignant cases of vocal cords, which can also cause hoarseness. So, as an ENT specialist it is important to rule out such malignancy occurring in the older age group.”
Causes of voice loss in senior citizens
- Presbyphonia: This is a collective word for ageing problems that affect voice in the older population, including muscle atrophy and bowing, and other changes in the voice box
- Spasmodic dysphonia: This a neurological condition that affects the muscles of the voice box (larynx) that go into spasms making the voice break or croaky while speaking
- Cancer of the vocal cords or larynx: Lesions can develop in the tissues of the vocal cords or the voice box that turn out to be malignant (cancerous). These can affect the voice quality and ability to talk
- Benign lesions: These are abnormal growths in the tissues of the vocal cords or the voice box that are non-malignant including cysts, vocal polyps and vocal nodules
- Laryngopharyngeal reflux: A condition wherein acid and other contents from the stomach back up into the oesophagus and all the way up to the larynx, causing cough and sore throat
According to the 2015 study ‘Perceived disability from hearing and voice changes in the elderly’ by Monini S et al published in the journal Geriatrics and Gerontology International, 65 per cent of senior citizens evaluated felt that the quality of their voice had altered and 31.5 per cent participants showed some type of pathology. The researchers felt that the implications of voice disorders in the elderly was often underestimated and suggested proper screening and therapy.
“In case of hoarseness of voice, we have to be alert to any underlying condition such as a lesion, growth or tumour in the vocal cords or voice box,” says Dr Datta Majumder. “Appropriate tests such as a larynx endoscopy or telelaryngoscopy (using a tube-like device with a camera and light at one end) can be done to see the vocal cords through the camera and ascertain their movement. We may have to remove the lesion by using laser and send it for biopsy (evaluation of tissue cells). If it is a benign lesion, the patient may require voice therapy for four to six weeks. If it is a malignant lesion, doctors will decide if the patient needs chemotherapy, radiation therapy or surgery based on the cancer stage. When the voice loss is part of the aging process, simple voice therapy and psychological counselling will help.”
Diagnosis and treatment
Presbyphonia can be treated in elderly persons with voice therapy sessions conducted by a trained speech therapist that will include exercises to strengthen the vocal cord muscles. Breathing exercises can also assist in regaining the voice.
Behavioural therapy can help senior citizens overcome voice disorders. When the hoarseness or voice problems are caused by cancer, appropriate treatment may include medications (chemo), radiation and/or surgery to remove the malignancy.