Of time and voice

I feel really young inside. I listen to rock music, so I must be young. After a few years’ layoff I recently started running again and couldn’t make it up a hill I have been able to fly up for decades. Now, I think that most likely someone has made the hill steeper, right? Maybe an earthquake altered the shape of the Earth’s crust. That’s possible. I mean, it’s the same me, but I can’t reach the same height. Of course, someone said, I could be older.

Voice is, in so many ways, what defines us as “us”. Age affects every part of us, at different rates in different people, but every part of us nonetheless. That includes how we sound with time. The fact that voice production depends on so many different body systems has some good and some bad implications for the voice.

It’s good, because a fall-off in one part of the system can be compensated to some extent by the other bits that might not have aged as quickly. It’s also bad, in that most often very small changes appear in several parts all at once. We need to address as many of these as possible if we want to keep our main tool of human communication, our ways of speaking to our family and friends, and keeping our business going, all in as good shape as possible for the rest of our lives.

What happens to your voice as you age?

So much effort goes into keeping people looking younger, yet some are concerned that their voices still sound “old”. This alteration in the voice can sometimes occur at remarkably young ages (from 50 onwards) depending on your genetics (probably, we don’t really know). Thus, the voice becomes breathier, “reedier” and harder to produce. It may break up during meetings or at social events, or we may find it harder to be heard over background noise at gatherings or restaurants.

The extra effort of speaking can lead to sore throats as the day wears on, due to tiring of the laryngeal muscles. We might also become a little light-headed when talking for a long time, due to extra air escape. And, of course, singing, at home, at church, or professionally, becomes a real disappointment.

Why do these changes occur?

Voice is the production of sound in the throat that we then shape with our lips, mouth, tongue into speech. Good voice starts with good hearing, so that the modulation and feedback are the best they can be. Then, the nerves between brain and lungs and voice-box all need to work well. The lungs need to be in good shape to generate the power needed to force air through our almost closed vocal cords, which themselves need to retain their beautifully engineered surface (mucosa). This mucosa, layered with different stiffness at different levels, is unique in the animal world, having adapted for the range of sounds we produce to communicate. The air pumped through by the lungs causes waves to be set up in this lining, which in turn generate and modulate the sound. The finely tuned muscles in the larynx and vocal cords need to be in good shape too to keep the tone of the cords when they close and to vary their length, and thus our pitch.

Sadly, every bit of this chain of structures and actions is slowly affected by the passing of time. It’s important that any deafness, nerve or lung problem is carefully managed, but here I will focus on the organ that interests me most: the voice box or larynx.

With age, the muscles of the larynx weaken (this is the same process, called “sarcopenia”, that my legs are suffering from going up that hill). This alters the way in which the vocal cords close, often leading, especially in advanced age, to a gap when we try and speak. As a result, much of the effort our (also weaker) respiratory muscles are putting into pumping air through the vocal cords is wasted as the cords cannot close perfectly and air (and air pressure) is wasted. This leads to a “reedy” quality of the voice, reduced volume and ability to raise the voice, and reduced vocal range.

At the same time, the body’s water content drops off – 10% by age 60. This alters the mechanics of those magical layers in our vocal cords and makes them less flexible. The result is a harsher sound (hoarseness), exacerbating the effects of weakness.

Are men and women’s voice affected in the same way?

These changes are not gender-specific. However, the net result is to bring both types of voice nearer the “median”: men’s voices become higher in pitch and women’s voices become lower.  This is really distressing when you are mistaken for someone of the opposite sex when talking to someone for the first time on the phone.

How can I look after my voice as I get older?

As with other parts of the body, including my legs, keeping the voice in great shape is a matter of care, common sense and, yes, exercise. So here are some tips:

1. At the simplest level, keeping well-hydrated (at least 1.5 litres of water or clear fluid a day, and more in warm weather) will keep the cords supple. There is good experimental evidence to back this up.
2. Keep fit. Your respiratory muscles are as important as your laryngeal muscles.
3. Making sure that your diet is well-balanced and avoiding things that might cause reflux (another common cause of voice problems with age, addressed in one of my other Top Doctors’ postings), such as spicy and acidic foods, fizzy and caffeinated drinks, will also help.
4. Look at the way you use your voice socially and at work, and if you think the load might be even a bit too heavy, then dial it back. If practical, is this “talky” or “shouty” job of yours really one you want need to continue and can you change? If you speak to groups regularly, then use an amplification device. Avoid shouting, whispering and throat-clearing as these place horrible strain on your laryngeal muscles.
5. If you are really worried and the simple things aren’t working, or possible (“I’m sorry, Dr Birchall, but I can’t just stop being a primary school teacher”), then it is probably worth seeing a laryngologist (an ENT surgeon specialising in the throat, like me) for a check-up to make sure that all the systems are as they should be. He or she may then be able to refer you to a voice therapist with an interest in the ageing voice. The voice therapist will do some diagnostics with you, then tailor a behavioural and voice exercise regimen to your specific problem, needs and wants. These guys are brilliant.
6. As a last resort for those with quite big gaps between the vocal cords with age, and only if the measures above do not help, some people may benefit from a small injection into the vocal cords to reduce the effort of talking. In the US, this is increasingly popular and is called a “voice lift” (kind of like a facelift, only for your voice, get it?). However, laryngologists still have no good way of predicting who will and who will not benefit from such injections so this can be a bit “hit-and-miss”.  Nonetheless, for some with severe problems, it may be an option.

Age is a thing. A real thing, and it can get to your voice. However, there is loads that can be done by you, or by us, to keep you talking, socialising, singing and working for many, many years to come.

I’ve changed my diet, I’m getting more sleep, and going for runs more often now. Yesterday I made it to the top of that hill without stopping, just like I did ten years ago.

To book an appointment with Professor Birchall, visit his Top Doctors profile.