Loss of Voice

The Aging Voice

Although significant voice disorder are estimated to affect 3-5% of the general population, up to 30% in the elderly population have significant problems in terms of voice durability, volume and/or embarrassing breathiness.

As the work force is increasingly composed of individuals 60 years of age or over, and as there is growing community awareness of strategies and interventions to address the ageing voice, this problem will be seen increasingly by primary care physicians.

Getting age-related changes in the voice

Patients with age related changes to the larynx typically present with complaints of hoarseness, weak or breathy voice, increasing vocal fatigue and changes in, or limitation in pitch.

Presbylaryngis or ageing of the larynx is a diagnosis of exclusion. It is defined as age related bowing of the vocal folds due to muscular and neurologic changes in an ageing individual.

Common physical examination findings are prominence of the vocal processes, flaccidity of the free edge of the vocal folds, significant mid laryngeal vocal gap, tilting of the arytenoids and excessive false vocal fold constriction.

Most of these changes are attributable to structural changes that occur over time. Alterations include changes in size and apparent thyroarytenoid muscle composition with increasing numbers of type II fibers, restructuring of vocal fold lamina propria reflecting decreased by hyaluronic acid composition and altered neuromuscular activity.

Presbylaryngis Treatment

Presbylaryngis Treatment

Nonsurgical Management

Nonsurgical management of presbylaryngis remains the cornerstone of therapy after appropriate diagnosis. Expert speech therapy, as single modality of treatment, has been shown to have significant qualitative benefits that are maintained over time.

Age related comorbidities such as compromised lung function, intercurrent neurological or degenerative disease, and medication related voice changes have obvious adverse effects on any treatment intervention.

Surgical Interventions for Presbylaryngis

When complaints persist after appropriate medical and physical therapy, the solution can be surgical intervention.

Vocal fold injection augmentation is a safe, effective, and often used modality to improved voice quality and glottic closure. Injectable materials vary according to their composition and the duration of their effects.

Large numbers of patients have been safely injected with all of these materials and they represent a first line of surgical intervention.

Injection laryngoplasty is tailored for each individual patient based on the patient’s occupation, voice requirements, expectations, medical morbidities, tolerance for ‘in office’ procedures and/or fitness for general anaesthetic.

Injectable materials are broadly classified as being temporary or permanent/long-lasting. The temporary category includes substances such as Hyaluronic Acid, Gelfoam, Surgicel, human collagen (Cymetra) and Radiesse Voice Gel. These products can last for weeks to months and are used as a temporary or predictive measure before the use of intermediate, long-lasting or permanent fillers.

Commonly used long-term injectables include autologous fat, calcium hydroxyapatite and polydimethylsiloxane.

Once the patient has been selected for injection laryngoplasty, a decision is made as to whether the procedure takes place in an office setting under local anaesthetic or in the operating room under general anaesthesia. For the vast majority of patients, in Australia, the latter is the preferred option but in an elderly patient with multiple comorbidities an office procedure represents an attractive alternative.

The Sydney Voice Clinic has the largest experience, in Australia, with injection laryngoplasty having performed the procedure since 1990 in over 500 patients.