A historical look at the aging voice The Journal of Voice 1987-2018
Edie R. Hapner, PhD
Michael M. Johns III, MD
Presbyphonia, or the aging voice, is a normal biological process that affects the respiratory, phonatory, resonatory, and articulatory quality, clarity, and efficiency of voice production (Kendall, 2007). It is a result of the natural decline in the neuromuscular, endocrine, skeletal, respiratory, vascular, and integumentary systems of the body (Ramig et al., 2001). Enthusiasm for studying the aging voice is often associated with the global population explosion of individuals over the age of 65, which is a result of aging baby boomers. But even a quick glance into the literature demonstrates that interest in the aging voice dates back to the 1950’s (Mysak, 1959) with attempts to describe the perceptual differences between old and young voices. In 1987, in the inaugural issue of the Journal of Voice, Harry Hollien asks, “‘Old voices’: What do we really know about them?” And so begins our journey through the descriptive and scientific study of aging voice and its diagnosis, behavioral and medical treatments, and prevention in the Journal of Voice 1987-2018.
This compendium of research will present many descriptive articles on the auditory perceptual, acoustic, aerodynamic, and laryngoscopic differences between young and old voices, as well as studies that demonstrate the preventative power of singing on features of the aging voice. Many of these articles are descriptive studies that have originated in countries outside the USA, and most are cross-sectional study designs. There remain few studies examining the differences between normal aging and disordered aging, and no studies looking at the difference between the aging treatment-seeking population and those that do not seek treatment. There are no longitudinal studies that look at the impact of voice use earlier in life predictive of the amount and speed of subsequent age-related deterioration (Gavrilov, 2014). The reader will note that there are limited studies documenting the surgical outcomes in the treatment of presbyphonia, but the Journal of Voice has 9 articles since 2012 looking at the impact of voice therapy on aging voice.
The first section of this book, Proceedings, highlights two articles from the first issue of the Journal of Voice. These transcriptions of proceedings from the fifteenth symposium, Care of the Professional Voice, New York, New York, June 2-6, 1986, are a fascinating look into the state of knowledge regarding aging voice at that time. The first question presented to the panel was the issue of looking at normal aging versus disease pre-aging or disordered aging. Dr. W. Chodzko-Zajko pointed out that attempting to study a geriatric superhuman, or someone who has no effects of their life lived, is an impossible subject to find, so researchers at that time had essentially avoided the dichotomy. In the transcriptions of the second panel, Dr. R. Sataloff discussed that aging is on a continuum that does not start at age 60+, but may be heard by the singing teacher in 30-year-old students. Dr. D. Bless commented that she had become interested in arresting the speed of aging through exercise similar to recent osteoporosis studies. She was beginning a line of research into the impact of physical fitness and exercise on vocal aging.
The second section of the book, Incidence and Prevalence, supports articles that examine vocal aging in Korea, Japan, Germany, El Salvador and the USA. Two articles on vocal aging of people in nursing homes looked at the impact of frailty on vocal aging.
The third section of this compendium, Clinical Features: Perceptual, Acoustic, Aerodynamic, and Laryngoscopic, supports the majority of articles published in the Journal of Voice. Well before the inaugural issue of the journal, work was published elsewhere on acoustic features of voice such as changes in jitter and shimmer with aging (see Proceeding, section one, Panel Discussion 1 and 2). Harry Hollien in his article, “‘Old voices’: What do we really know about them?” (1987) discusses the stigma in society at the time regarding sounding elderly. Susan Linville, in her seminal article, “The sound of senescence” (1996), summarized the research to date on the changes in voice with aging and the accuracy of listeners to perceive age from voice alone.
Many articles in this section examined the voice in a cross-sectional manner looking at multiple aged cohorts and specific features. Several papers, including Yamauchi and colleagues (2012, 2013, 2014, 2015) utilized high-speed digital images to examine changes across age groups to study the glottal area waveform. Many authors examined the acoustic and aerodynamic changes across several age cohorts including Shipp and colleagues (1992), Linville and Rens (2001), and Goy and colleagues (2013). Thirty years later, studies on the acoustic differences in young and older voices continue as our understanding of acoustic information grows. Studies using newer measures such as pitch strength as an outcome measure (Kopt et al., 2017) or optimization of the study of spectrographic features (Messedimi et al., 2017) continue to be published in the journal.
Several papers examined the impact of singing on aging voice and reported, in most cases, that singing has a protective influence on slowing the speed of vocal decline in aging (Brown, Morris, Hollien & Howell, 1991; Boone, 1997; Gregg, 1997; D’haeseleer, Claeys, et al., 2016)
Section four presents therapies, Voice therapy, Surgical therapy, and Alternative therapy. There are a surprisingly small number of articles on therapies for aging voice with voice therapy predominating. Among the first articles examining the impact of voice therapy on aging voice appeared in 2007 (Lombard & Steinhauer, 2007) and then no articles on voice therapy appeared in the journal until 2012. Since that time, articles examining the usefulness of vocal function exercises (Tay et al., 2012; Kaneko et al., 2015; Angadi, Croake & Stemple, 2017) appear most often as the treatment for presbyphonia. Two cases of the use of Lee Silverman Voice Therapy (Lu, Presley & Lammers, 2013) and one article on using an open jaw posture (Mautner, 2015) are also a part of the compilation.
Studies on surgical therapies are quite limited in the journal. Three surgical articles were identified in the journal to date. One of the articles documented injection augmentation (Carroll & Rosen, 2010); one compared injection to temporalis graft implantation (Tan et al., 2011), with one, very recent article, documenting bilateral thyroplasty in the treatment of presbylaryngeus (Allensworth et al., 2018). Lastly, one article, identified as alternative therapy in the compendium, looked at the impact of environmental hydration during a vocal loading task in older adults (Sundarrajan et al., 2017).
The final section of the book presents articles on basic science including modeling of neural networks (Silva, Vellasco & Cataldo, 2017). Several articles examined morphologic changes to the larynx: Thomas, Harrison and Stemple (2008) and Thibeault, Glade, and Li (2006). These articles represent the growing trend to study aging in voice similarly to methods used to study aging in other skeletal muscle. Three articles looked at sex hormones both within the vocal folds and circulating in males and females (Abitbol et al., 1999; Newman, Butler, Hammond & Gray, 2000; and Gugatschka et al., 2010).
Certainly there are articles that may have been inadvertently omitted in this compilation of the aging voice research from the Journal of Voice, and the authors apologize for any inadvertent omissions. This compendium is a result of the combined work of the authors and their team of dedicated students and fellows. A very special thanks to Hillary Enclade, Lauren Timmons, and Kristen Bond for their significant contributions to this work. We hope you enjoy reading this compendium of articles over the last 30 years in the Journal of Voice.
Acknowledgements: Special thanks to Lauren Timmons Sund, Hilary Enclade, and Kristen Bond for their invaluable assistance with this manuscript.
Edie R. Hapner, PhD CCC-SLP, ASHA-F
Co-Director, UAB Voice Center
Director, Otolaryngology Speech and Hearing Services
Department of Otolaryngology – Head and Neck Surgery
The University of Alabama at Birmingham
Michael M. Johns, III MD
Director, USC Voice Center
Division Director, Laryngology
USC Caruso Department of Otolaryngology Head and Neck Surgery
Keck School of Medicine
University of Southern California
Los Angeles, CA
1. Kendall, Katherine. "Presbyphonia: A Review." Current Opinion in Otolaryngology & Head and Neck Surgery Issue: Volume 15(3), June 2007, p 137–140
2. Ramig L, O, Gray S, Baker K, Corbin-Lewis K, Buder E, Luschei E, Coon H, Smith M, The Aging Voice: A Review, Treatment Data and Familial and Genetic Perspectives. Folia Phoniatr Logop 2001; 53:252-265
3. Mysak, E. Pitch and duration characteristics in older males. J Speech Hearing Res 1959; 2: 46–54.
4. Gavrilov LA, Gavrilova NS. Predictors of Exceptional Longevity: Effects of Early-Life Childhood Conditions, Midlife Environment and Parental Characteristics. Living to 100 monograph. 2014:1-18.