Just as vision and hearing change over time, aging can also lead to changes in the larynx that can cause a decrease in voice volume or a change in pitch or tone.

And, while a change in voice is not a life-threatening condition, it can alter the way a person goes through life or is perceived in the world. Speaking too quietly can affect how often and where they socialize with friends and family. It can also interfere with a person’s ability to work if verbal communication is a critical part of their job.

Jed Dannenbaum never had one of those big, booming voices that would fill a room. The historian and documentary filmmaker says he was always on the soft-spoken end of the vocal spectrum but, in recent years, it was becoming harder to speak above a whisper.

“Going out with friends, trying to talk at family gatherings, had become problematic,” says Dannenbaum, PhD, who is also a professor in the USC School of Cinematic Arts. Trying to make himself heard was increasingly difficult and often left his voice tired and raw.

When his wife started having trouble hearing him even in the quiet of their home, he decided to seek help from the USC Voice Center at the USC Tina and Rick Caruso Department of Otolaryngology–Head and Neck Surgery.

Recent changes in technology have given new power to laryngologists who specialize in problems with the voice. New, high resolution endoscopes allow doctors to view slow motion images of the vocal cords in action.

“For the first time we can actually see what they are doing and spot subtle abnormalities that we couldn’t before,” says Michael Johns III, MD, director of the USC Voice Center and professor of clinical otolaryngology–head and neck surgery at Keck Medicine of USC.

Using one of these endoscopes, Lindsay Reder, MD, assistant professor of clinical otolaryngology–head and neck surgery at Keck Medicine of USC, was able to watch Dannenbaum’s vocal cords in action while he spoke. She was also able to determine that his vocal cords no longer meet in the middle when he speaks, which is a fairly common byproduct of aging, and can cause decreased volume.

Like many patients, Dannenbaum initially opted to try voice therapy and only began exploring other options when that failed to bring back significant volume. The USC Voice Center is the only integrated practice of laryngologists and speech pathologists specializing in voice in Southern California, offering patients like Dannenbaum seamless care. Dannenbaum says Dr. Reder discussed various options to help raise the volume of an aging voice.

“She spent a lot of time talking me through it and explaining things in detail,” says Dannenbaum.

Dannenbaum chose to have fillers injected into the folds of his vocal cords. Using many of the same fillers that are used to plump up wrinkled skin, such as hyaluronic acid or micronized acellular dermis, to bulk up a patient’s vocal folds is a relatively new treatment.

Though not a permanent solution, Dannenbaum said the idea of an outpatient procedure that involved only a local anesthetic and less than a half hour of his time appealed to him.

Only a few days after his procedure, Dannenbaum’s voice was already stronger and he’s looking forward to testing the strength of his newly pumped up voice in the classroom and at gatherings of friends and family.

Three Ways to Raise the Volume

1. Voice Therapy

The first line of treatment for anyone suffering unwanted effects of an aging voice is voice therapy. Edie Hapner, PhD, professor of clinical otolaryngology head and neck surgery at Keck Medicine of USC, says that many people experiencing trouble with an aging voice mistakenly think they need to rest their vocal cords. Just the opposite is true. Just as muscles that have atrophied need strengthening, the muscles in the larynx also benefit from a rigorous workout. Hapner says most patients will require four to six sessions with a speech pathologist, who assigns them a series of progressively more difficult voice exercises, to make a major change.

2. Implants

Some patients may need an implant to keep the folds of the vocal cords together. This solution is the most permanent, but requires surgery. Surgeons make an incision in the patient’s throat to insert a device that holds the folds around the vocal cords together. The patient is kept awake and can speak, which allows the doctors to make sure the device is serving its purpose.

3. Fillers

Fillers that are better-known for smoothing out wrinkles can also be injected to plump up the layers of vocal folds that thin over time. This outpatient procedure takes only a few minutes and a local anesthetic. Depending on the patient, the filler may last for a few months or as long as a year before the procedure needs to be repeated.

Learn more at: ent.keckmedicine.org

by Hope Hamashige