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Addressing Age-Related Voice Changes

Edie Hapner, PhD, and VyVy Young, MD

Turning Back the Clock: Optimizing Treatment of Age-Related Voice Changes
8:45 am, Today
Room 386/387

Vocal folds change with age, often resulting in pitch changes, reduced loudness, dysphonia, and an overall weakening of the voice. Patients who seek treatment for age-related voice changes may not be aware that there are various approaches that can improve their functionality, and otolaryngologists must make complex decisions in counseling patients about the best treatment options.

The least invasive approach is to simply monitor the patient and do nothing. A significant voice change can be alarming, and patients may be worried about life-threatening conditions, such as cancer. Simply learning that their voices have changed due to normal aging can be a relief, and for some patients, no treatment is the best option. For others, the voice changes can significantly impair their ability to function, and thus treatment aimed at improving these symptoms may be desired.

Depending on a host of factors, voice therapy may be a beneficial treatment approach; however, there are several critical factors for physicians to consider before suggesting therapy.

“There are several evidence-based therapies that can improve voice, but not everyone is a good candidate for therapy,” said Edie R. Hapner, PhD, Professor of Clinical Otolaryngology-Head and Neck Surgery and Director of Speech Pathology at Keck School of Medicine of USC.

Dr. Hapner said one concern otolaryngologists may have is whether the patient has access to a qualified speech language pathologist. Without the guidance of a skilled clinician, this treatment avenue may not lead to a satisfactory outcome for the patient. Another important factor is determining if the patient needs to continue long-term use of some level of therapeutic exercises in order to maintain his or her progress.

The third treatment option available to patients with age-related voice changes is surgery, typically in the form of vocal augmentation. For some patients, the improvement in voice can be profound, but for others the changes may be less impactful. Because the patient population most affected by age-related voice changes is elderly, and perhaps frail, the risks and benefits of surgery should be weighed carefully. Otolaryngologists must consider whether patients have comorbidities as well as how the patient feels about surgery.

“Sometimes, you just say the word ‘surgery,’ and they say ‘no’. They are just done,” said VyVy N. Young, MD, an Associate Professor of Clinical Otolaryngology at the University of California, San Francisco. “Other people want you to talk to them about what the surgical options might look like.”

In addition to understanding how each treatment option may fit into their patients’ lives, otolaryngologists have to make decisions about their own roles. After this session, attendees will have a better understanding of “what the treatment options are, what they should present to patients, what the pros and cons of each treatment are, and what is entailed in pursuing each option,” said Dr. Young. “It’s all about knowing and understanding the options.”