aging voice importent
TRANSCRIPT
-
8/4/2019 Aging Voice Importent
1/32
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
-
8/4/2019 Aging Voice Importent
2/32
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
-
8/4/2019 Aging Voice Importent
3/32
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
-
8/4/2019 Aging Voice Importent
4/32
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
-
8/4/2019 Aging Voice Importent
5/32
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
-
8/4/2019 Aging Voice Importent
6/32
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
-
8/4/2019 Aging Voice Importent
7/32
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
-
8/4/2019 Aging Voice Importent
8/32
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
-
8/4/2019 Aging Voice Importent
9/32
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
-
8/4/2019 Aging Voice Importent
10/32
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
-
8/4/2019 Aging Voice Importent
11/32
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
-
8/4/2019 Aging Voice Importent
12/32
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
-
8/4/2019 Aging Voice Importent
13/32
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
-
8/4/2019 Aging Voice Importent
14/32
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
-
8/4/2019 Aging Voice Importent
15/32
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
-
8/4/2019 Aging Voice Importent
16/32
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
-
8/4/2019 Aging Voice Importent
17/32
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)
-
8/4/2019 Aging Voice Importent
18/32
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
-
8/4/2019 Aging Voice Importent
19/32
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
-
8/4/2019 Aging Voice Importent
20/32
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
-
8/4/2019 Aging Voice Importent
21/32
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
-
8/4/2019 Aging Voice Importent
22/32
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
-
8/4/2019 Aging Voice Importent
23/32
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..
-
8/4/2019 Aging Voice Importent
24/32
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
-
8/4/2019 Aging Voice Importent
25/32
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
-
8/4/2019 Aging Voice Importent
26/32
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)
-
8/4/2019 Aging Voice Importent
27/32
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)
-
8/4/2019 Aging Voice Importent
28/32
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)
-
8/4/2019 Aging Voice Importent
29/32
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
-
8/4/2019 Aging Voice Importent
30/32
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
-
8/4/2019 Aging Voice Importent
31/32
ReferencesReferences
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
-
8/4/2019 Aging Voice Importent
32/32
ReferencesReferences
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.