Vocal Changes and Laryngeal Modifications in the Elderly (Presbyphonia and Presbylarynx) (Reprinted)

In about 20 % of the population older than 60 years of age, voice problems (presbyphonia) are manifest, often combined with hearing deficits (presbyacusis), swallowing disorders (presbyphagia), dizziness (presbyvertigo) and/ or impaired vision (presbyopia). The singing voice is afflicted more often, earlier and more severely than the speaking voice. But it is not just the vocal quality and capacity that are affected. Due to reduced pulmonary function, the breathing impetus is also weakened. As a result of the descending of the larynx, resonance properties of the vocal tract change in seniors, and there is increased risk of aspiration. Vocal deficits are caused by age-related morphological changes in the larynx (presbylarynx). These alterations concern both the ectolaryngeal skeleton and the endolaryngeal soft tissues (particularly the vocal folds). The vocalis muscle atrophies and becomes hypotonic, which becomes clinically apparent as vocal fold bowing and spindle-shaped glottic chink with loss of air during phonation. The laryngeal mucosa dries out (laryngitis sicca). Vocal rehabilitation in the elderly includes both general and voice-specific therapeutic options. Underlying internal and neurological diseases (e.g. reflux, neurodegenerative or cerebrovascular affections), as well as side effects of drugs must be considered. A healthy lifestyle without pathogenic agents promotes good function of phonatory and respiratory organs. As far as voice therapy is concerned, glottal attack exercisescan improve glottal closure during phonation, and relaxation exercises may reduce supraglottic hyperfunctional compression. In special cases with large glottic chink, phonosurgical augmentation of the vocal folds may enhance glottal closure and vocal strength. Vocal hygiene (e.g. regular airway moisturisation) complements voice exercises. In the elderly, singing has proven pychosocial benefits (improvement of well-being and social participation) and verified positive immunological effects (salivary IgA increase).