Let Your Voice Be Heard
When singers like Mick Jagger and Paul McCartney perform for decades, their fans see many changes: their fashions, their style of music, and even their voices. While some voice changes are a normal part of aging, 10 to 30 percent of people over the age of 65 experience more significant problems.
WHAT YOU CAN DO
To practice good vocal hygiene:
DON’T:
- Shout
- Talk loudly over noise
- Clear your throat excessively
- Overuse dehydrating substances, such as antihistamines, alcohol, and caffeine
- Smoke
- Talk through sickness
- Consistently use either a very high or very low end of your vocal range
DO:
- Treat excessive mucus if needed
- Avoid lengthy conversations on the phone
- Rest your voice for 10 minutes for every two hours of talking
- Drink water
- If you’re in a dry environment, use a humidifier
Source: University of Texas San Antonio
Defining Voice Disorders. People with a voice disorder (dysphonia) may have trouble with the pitch, volume, or quality of their speech. Their voices may sound weak, hoarse, rough, breathy, strained, strangled, gurgled, nasal, shrill, tremulous, or creaky. They may have breaks in their speech or lose their voices altogether. They may need to work harder to speak and tire quickly. Speaking may cause them to cough, clear their throats, or experience pain.
There are many causes of voice disorders, including genetic factors, occupational overuse (such as in teachers and singers), medications, trauma, habits like smoking, illness, neurological issues, and even chronic stress, according to the American Speech Language Hearing Association.
Few People Seek Treatment. While many cases of dysphonia respond well to treatment, only a small number of people see a doctor about their voice problems, according to a study published in August in JAMA Otolaryngology Head & Neck Surgery. In a cross-sectional study that used the 2012 National Health Interview Survey, the researchers identified 4.2 million Americans 65 years of age or older who reported having voice disorders—but just 10 percent of them pursued treatment.
Treatment Is Often Successful. The Voice Foundation notes that, in most cases, voice function can be improved or resolved with appropriate treatment. Treatment may consist of voice therapy, medication, surgery, or a combination of elements.
Voice therapy teaches people how to use their voices correctly. It can teach patients to avoid the kind of voice misuse and abuse that can cause vocal fold nodules, cysts, or polyps. If those lesions are already present, voice therapy can help them heal. It can also teach patients compensation strategies to overcome vocal weaknesses.
Medication. If there are underlying conditions causing or contributing to a voice disorder, medication may help. Someone who is experiencing voice loss due to acid reflux, for example, may need an acid-reducing medication in his or her treatment plan, while a person with a hypothyroidism-related voice disorder may benefit from monitoring and treatment of low thyroid hormone levels. Botulinum toxin type A can ease voice disorders caused by muscle spasm, while allergy treatments may be needed to reduce mucus in the throat.
Surgery may be needed to remove vocal fold lesions or abnormalities, or to improve vocal fold closure. Certain conditions may be treated with injections of fat or collagen.
While voice changes may be a normal part of aging, if you experience voice problems that are interfering with your ability to communicate, don’t ignore it. Talk to a physician (such as a laryngologist or an ear, nose, and throat specialist) or a speech language pathologist to determine the cause of your dysphonia and develop a treatment plan.
THE VIEW FROM DUKE
Don’t Suffer in Silence
“Voice disorders are a common problem in older adults that adversely impact communication and can lead to social isolation and depression. The causes can range from benign to malignant. While age-related changes to the vocal folds and voice box occur, serious voice disorders such as laryngeal cancer and vocal fold paralysis are more common in older adults. Many reasons, such as being unaware that voice problems can be serious and not knowing that treatment exists, may explain why many patients with voice problems do not get care. Varied treatment approaches exist and have been shown to be effective. Specific treatment can be tailored to the patient based on their diagnosis and communication needs. The most important take-home point is that if you have voice problems for four weeks, you need to see an ear, nose, and throat specialist who can examine your vocal folds and determine the diagnosis and next steps.”
SETH COHEN, MD, MPH,
Associate Professor of Surgery,
Head and Neck Surgery &
Communication Sciences,
Duke University School of Medicine
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