Age-related voice alterations (dysphonia or presbyphonia) can affect 1 in 3 elderly individuals and significantly impact the quality of life.

Physicians at the USC Voice Center are experts at diagnosing vocal changes across different types of patient conditions. A core diagnostic tool is careful evaluation of the patient’s voice by trained listeners and computerized voice assessment. We also use painless, minimally invasive ways to visualize the voice box and vocal cords and provide state-of-the-art diagnostic information for the patient’s voice change.

With the changing demographics in the United States, it is expected that physicians will be seeing more patients with age-related vocal changes.

Recognizing the changes

Common age-related vocal changes:

  • Reduced projection and volume
  • Pitch change
  • Loss of vocal stability
  • Breathy quality to the voice
  • Reduced vocal endurance

Treatment options

After a diagnosis is made, physicians can treat vocal changes with several procedures. Vocal strengthening exercises are often the first treatment attempted and can be highly successful for many conditions. At the USC Voice Center, speech pathologists, who have specialized training in age-related dysphonia, work with patients to provide attentive and individualized vocal strengthening programs. A novel vocal training program, PhoRTE, was developed by the team at the USC Voice Center to make vocal strengthening convenient and mostly from home. In a clinical trial performed by USC clinicians, PhoRTE was shown to be effective for most patients.

If a patient is not sufficiently improved with vocal strengthening exercises alone, physicians can also perform vocal cord injection to bulk aged vocal cords. In this procedure, safe filler material is injected into the vocal cords to augment their size, shape, and their performance. Vocal cord injections are performed in the office using minimally invasive techniques while the patient is awake.

Another option to treat age-related vocal changes is to place implants next to the vocal cords which allows them to meet and function better during voicing. This is a more permanent correction for vocal cord atrophy/aging. This procedure is performed in an operating room awake with light sedation. Our surgeons custom shape the implants during the procedure with real-time vocal feedback from the patient.

Voice changes with aging can be caused by a variety of conditions. Only 25% of the time are a patient’s vocal changes entirely related to aging; 75% of the time, the vocal changes are associated with other conditions.

Any vocal change lasting longer than two weeks needs to be evaluated by an otolaryngologist.

Presbyphonia research

In addition to the clinical treatments offered, physicians at the USC Voice Center have a robust research program for age-related dysphonia. Research highlights include the development of a mouse model for the aging larynx and the treatment of essential vocal tremor with propranolol and botulinum toxin.

Several vocal cord rejuvenation techniques are being studied, including stem cell therapy and scaffold implantation. Faculty members are also looking into injecting growth factors into vocal cords and have developed an extended-release delivery system for growth factors. Principal investigators at the USC Voice Center are planning a clinical trial on vocal cord rejuvenation to begin shortly.

Age-related dysphagia

Though it is not as common as age-related dysphonia, age-related dysphagia is a serious condition that should be treated. Individuals often lose muscle strength and coordination with age. In addition, there is often an age-related loss of feeling in the throat and voice box, which can lead to an increased risk of aspiration. Any patient that presents with dysphagia is assessed by an interdisciplinary team of laryngologists and speech pathologists. Treatment for dysphagia often involves a combination of pharyngeal and/or laryngeal strengthening exercises, behavioral modifications, and sometimes surgical intervention.

Our team of physicians and speech pathologists is committed to providing patients with the most advanced and appropriate care for their voice and swallowing.