Walking the thin white line – managing voice in the older adult. (2nd January 2019) - Allen, Jacqui
ABSTRACT: Purpose of review: This article reviews our understanding and the evolution of management of age-related vocal changes and phonatory complaints in the older adult, from the otolaryngologist and speech-language therapists' perspective. Recent findings: Vocal change may occur with ageing but may not produce problematic symptoms or dysfunction. A perceptually 'older voice' is often characterized by breathiness, reduced projection and increase vocal fatigue. Physical changes observed include vocal fold atrophy with incomplete glottal contact whilst histologically there is a reduction in muscle fibre diameter, variation to the composition of the superficial lamina propria and alteration in viscoelasticity. When coupled with additional changes in the respiratory system such as a decline in breath support, reduced lubrication and global sarcopenia, glottal function may decline and audible or perceptual disturbances become apparent. In individuals who are bothered by phonatory decline, speech therapy and selected surgical interventions have demonstrated favourable responses and patient satisfaction. Growth factor and molecular therapies hold promise in the future. Summary: As people today continue to work and contribute to Society well into their ninth decade, functional voice holds greater importance. Understanding of occurrence of pathology as well as ageing effects is needed to ensure early appropriate assessment and provide a treatment where needed, thereby limiting the occupational impact and social isolation.