Glottal airflow characteristics of women's voice production along an aging continuum

Vocal Fold Vibration in Older Adults With and Without Age-Related Dysphonia

PURPOSE

The purpose of this study was to identify the extent to which 7 measures of glottal area timing and regularity differ between older adults with and without age-related dysphonia (ARD).

METHOD

Laryngeal high-speed videoendoscopy was completed at 4,000 frames per second for 42 adults aged 70 years and older (ARD: 9 female, 5 male; control group: 15 female, 13 male). Relative glottal gap, open quotient, speed index, maximum area declination rate, harmonics-to-noise ratio, harmonic richness factor, and standard deviation of fundamental frequency were measured from a 0.5-s segment of the glottal area waveform. Eta squared (η2) was computed to estimate group effect.

RESULTS

Small effect sizes (η2 = .18-.35) were present for relative glottal gap, open quotient, maximum area declination rate, harmonic richness factor, and standard deviation of fundamental frequency. Speed index and glottal harmonics-to-noise ratio did not explain group membership (η2 = .001 and .05, respectively).

CONCLUSION

These findings provide evidence that vocal fold vibration in ARD is different than in normal aging, whereas the overlap in values for every measure is consistent with the concept that normal aging and ARD exist as a continuum of health and disease.

Defining the lived experience of older adults with voice disorders

OBJECTIVES

The purpose of this qualitative phenomenological study was to gather rich thick descriptive data regarding the lived experiences of older adults seeking treatment for a voice disorder.

DESIGN

Using qualitative methodologies, participants completed semi-structured interviews with trained investigators to detail their thoughts, beliefs, feelings, and experiences of living with a voice disorder. Using a process of horizontalization, themes were identified that described the experiences of older adults with voice disorders.

SETTING

Research was conducted at four clinical voice centers in Kentucky, Wisconsin, and Ohio. Data were analyzed in the Laryngeal and Speech Dynamics Lab at the University of Kentucky.

PARTICIPANTS

A total of 28 adults (aged 65-90 years) with voice disorders were recruited for this study.

RESULTS AND CONCLUSIONS

Aging adults demonstrated a strong urge to communicate; however, they tended to describe their voice quality in negative terms and were emotionally impacted by these associations. They admitted to withdrawing from some activity or social event because their voice did not meet their expectations or voice needs; thought their voice quality was part of normal aging; and had resigned to accept their current voice.

Changes in acoustic characteristics of the voice across the life span: measures from individuals 4-93 years of age

PURPOSE

The purpose of the present investigation was to examine acoustic voice changes across the life span. Previous voice production investigations used small numbers of participants, had limited age ranges, and produced contradictory results.

METHOD

Voice recordings were made from 192 male and female participants 4-93 years of age. Acoustic measures of fundamental frequency (F0), sound pressure level (SPL), and signal-to-noise ratio (SNR) were made. Coefficients of variation for F0, SPL, and SNR served as measures of variability. Variables were analyzed separately with stepwise regressions, using age and sex as predictors.

RESULTS

Differences in F0 and SNR across the life span were sex specific. Male and female participants demonstrated significant nonlinear trends for F0, but the trends were stronger for male participants. Female participants demonstrated a similar nonlinear trend for SNR, whereas male participants demonstrated linear increases in SNR with age. Variability of F0, SPL, and SNR followed nonlinear trends, higher at younger and older ages.

CONCLUSIONS

Changes in voice production occur throughout the life span, often in a nonlinear way and differently for male and female individuals. Higher variability of acoustic measures of voice in both young and old speakers reflects changes in anatomic structure, physiologic mechanisms, and motor control.

Using laryngeal electromyography to differentiate presbylarynges from paresis

PURPOSE

Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from previous studies with presbylarynges and significantly different from those of patients with abnormal LEMG.

METHOD

A retrospective chart review of acoustic, aerodynamic, endoscopic, and self-rating measures was completed for 52 individuals over 64 years of age reporting moderate to severe hoarseness.

RESULTS

Individuals with normal LEMG had measures similar to those of patients from previous studies diagnosed with presbylarynges. The group with LEMG abnormalities was subcategorized by specific nerve(s) affected. Significant differences were found for measures between presbylarynges and unilateral but not bilateral paresis groups. Several endoscopic findings were observed more often than expected in the presbylarynges group. Using electromyography as a gold standard, the presence of any impairment in arytenoid movement had the most sensitivity (77%) in making the diagnosis of paresis, and the absence of any impairment had the most specificity (67%) in making the diagnosis of presbylarynges.

CONCLUSION

LEMG may be useful in differentially diagnosing hoarseness in older patients, especially to distinguish between bilateral paresis and presbylarynges.

EGG open quotient in aging voices—changes with increasing chronological age and its perception

This paper presents the results of open quotient (OQ) measurements in electroglottographic (EGG) signals of young (18-30 years) and elderly (60-82 years) male and female speakers. The paper further presents quantitative results of the relation between the EGG OQ and the perception of a speaker's age. Higgins and Saxman found a decreased EGG OQ with increased age for females, while the EGG OQ increased for males as the speaker's age increased in sustained vowel material 1. Although laryngeal degeneration due to increased age seems to occur to a lesser extent in females, the significant decrease of the OQ in elderly female voices could not be explained in terms of age-related physiological changes. Linville found increased spectral amplitudes in the region of F0 for the elderly (obtained by long-term average spectra (LTAS) measurements of read speech material), independent of gender, which could be indirectly interpreted as an increasing OQ 3. We measured the EGG OQ, not only for sustained vowels but also in vowels taken from isolated words and read speech material. To analyse the relation between breathiness in terms of an increased EGG OQ and the mean perceived age per stimulus, a perception test was carried out, in which listeners were asked to estimate speaker's age based on sustained /a/-vowels varying in vocal effort (soft-normal-loud) during production. 1) The decreased EGG OQ for elderly females originally found by Higgins and Saxman 1 is not apparent in our data for sustained /a/-vowels; for males, however, we also found an increased EGG OQ for the elderly speakers. 2) In addition, an increased EGG OQ for the group of elderly in comparison to the younger males occurs for the unstressed syllable of the word material. 3) Our results show a strong positive relation between perceived age and EGG OQ in male vowel stimuli. Regarding 2), depending on the speech task at least a male speaker's voice gets more breathy as age increases. Considering 3), increased breathiness may contribute to the listener's perception of increased age.

Influence of Aging and Sex on Voice Parameters in Patients with Unilateral Vocal Cord Paralysis

OBJECTIVES

The objective of this study was to investigate influences of aging and sex on different voice parameters in patients with unilateral vocal cord paralysis (VCP).

STUDY DESIGN

Retrospective review of patients with unilateral VCP.

MATERIALS AND METHODS

Forty-seven patients, 22 males, 25 females (24-85 years), were enrolled in the study. The diagnosis of VCP was established by videolaryngostroboscopy. The acoustic parameters of jitter, shimmer, degree of subharmonic, noise to harmonic ratio, fundamental frequency, and maximal intensity were measured. The auditive voice analysis included roughness, breathiness, and hoarseness. Statistical analysis involves Pearson's bivariate correlation coefficients and two-way analysis of variance with interaction variables.

RESOLUTION

After unilateral VCP in the elderly, some sex- and age-related differences in the restriction of the voice can be documented.

CONCLUSION

In general, the investigated voice parameters showed similar tendencies to those in otherwise healthy aging persons.

Age-related changes to speech breathing with increased vocal loudness

PURPOSE

The present study examines the effect of normal aging on respiratory support for speech when utterance length is controlled.

METHOD

Fifteen women (M = 71 years of age) and 10 men (M = 73 years of age) produced 2 sentences of different lengths in 4 loudness conditions while respiratory kinematics were measured. Measures included those related to lung volume and chest wall movements.

RESULTS

Data from the older adults were compared with previously published data from 30 young adults. A significant Age x Sex effect was demonstrated. Older men produced speech at higher lung volumes than younger men. No significant differences existed between older and younger women. Older adults tended to use more abdominal movement in loud speech than younger adults, especially when talking in noise. Some of the mechanisms used by the older adults to support increased loudness in response to the cues differed from those used by the younger adults. Age-related differences were larger when participants produced the longer utterance as compared with the shorter one.

CONCLUSIONS

Reduced chest wall compliance, pulmonary elastic recoil, and laryngeal closure may explain the findings. These data can be used to help distinguish normal age-related changes from disease-related changes.

Voice Therapy Improves Quality of Life in Age-Related Dysphonia: A Case-Control Study

The objective of the study is to determine the efficacy of voice therapy in the treatment of age-related dysphonia. The study was conducted using a retrospective case-control chart review. The medical records of 54 patients older than 60 years diagnosed with age-related dysphonia without complicating diagnoses were reviewed. Patients who chose to undergo voice therapy were grouped as cases. Patients who chose not to undergo voice therapy were grouped as controls. The voice-related quality of life (VRQOL) measure was used to measure outcomes before and after treatment in cases and at a minimum 2-month follow-up in controls. Of the 54 patients, 19 (10 female, 9 male; mean age 73 years) chose to undergo voice therapy and filled in >1 VRQOL questionnaire. Six patients (3 female, 3 male; mean age 66 years) chose not to undergo voice therapy and filled in >1 VRQOL questionnaire. The 19 cases experienced a mean improvement in VRQOL score of 19.21 (2-tailed matched pairs t test P=0.00038) after a mean of 4.1 voice therapy sessions and 5.1 months. The six controls experienced a mean change in VRQOL score of 0.42 (2-tailed matched pairs t test P=0.96) after a mean of 3.3 months. Voice therapy leads to statistically significant improvement in the VRQOL life in elderly patients with age-related dysphonia. It is an efficacious noninvasive therapy for this disease.

Temporal sequence of swallow events during the oropharyngeal swallow

PURPOSE

To (a) identify and characterize the temporal relation of selected structural movements during the oropharyngeal swallow across participants, (b) determine whether patterns of movement could be identified, and (c) determine whether the temporal relations were affected by aging and bolus characteristics.

METHOD

Retrospective analysis of videofluoroscopic swallows of 100 normal participants (age range=22-92 years) was conducted. Two swallows each of 3-ml and 10-ml liquids and a 1-3-ml paste bolus were analyzed. The onset of a number of structural movements and bolus arrival points were compared against a single reference event: onset of upper esophageal sphincter (UES) opening.

RESULTS

Normal participants demonstrated predominant sequences in pharyngeal movement patterns with some variability. The use of voluntary swallow maneuvers by these normal participants accounted for some degree of this variability. Volume, consistency, and age all affected the temporal relation between onset of specific motor events relative to the onset of UES opening. Increasing bolus volume was associated with a shorter temporal difference between UES opening and onset of other pharyngeal movements. In contrast, a thicker bolus was associated with longer temporal differences. Younger participants generally demonstrated shorter temporal differences between events than did older participants.

CONCLUSION

Temporal relations between structural movements are not fixed but can be systematically affected by bolus characteristics and age.

Presbyphonia: a review

Recent research has led to greater understanding of the physiologic and cellular factors involved in the aging of laryngeal tissues, and concurrent advances in treatment promise improvements in clinical outcomes. This article reviews the current medical literature with respect to the age-related clinical and pathological changes in the larynx leading to presbyphonia.

Glottic Characteristics and Voice Complaint in the Elderly

This study evaluated the relationship between voice complaint and deviant vocal fold status with special regard to presbylarynx, in patients aged more than 60 years, with pharyngeal-laryngeal complaint. The material consisted of clinical histories and images obtained by laryngoscopies from protocols from the Larynx Institute-INLAR, Sao Paulo, Brazil, of 210 patients, 88 men and 122 women, aged more than 60 years, who had sought otorhinolaryngologic treatment. Indicative glottic characteristics of the presbylarynx, such as vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink, were analyzed. The increase in mass, leukoplakia, and other vocal fold alterations, distinct from these two, grouped as miscellaneous, as well as the presence or absence of voice complaint were also analyzed. Vocal fold bowing, prominence of vocal processes, and spindle-shaped glottic chink showed a strong correlation among each other. The presence of presbylarynx was accompanied by less voice complaint than the presence of vocal fold mucosa alterations, which in turn are more common where an absence of presbylarynx exists.

Vocal aging and the impact on daily life: a longitudinal study

Longitudinal studies on vocal aging are scarce, and information on the impact of age-related voice changes on daily life is lacking. This longitudinal study reports on age-related voice changes and the impact on daily life over a time period of 5 years on 11 healthy male speakers, age ranging from 50 to 81 years. All males completed a questionnaire on vocal performance in daily life, and perceptual and acoustical analyses of vocal quality and analyses of maximum performance tasks of vocal function (voice range profile) were performed. Results showed a significant deterioration of the acoustic voice signal as well as increased ratings on vocal roughness judged by experts after the time period of 5 years. An increase of self-reported voice instability and the tendency to avoid social parties supported these findings. Smoking males had a lower speaking fundamental frequency compared with nonsmoking males, and this seemed reversible for males who stop smoking. This study suggests a normal gradual vocal aging process with clear consequences in daily life, which should be taken into consideration in clinical practice as well as in studies concerning communication in social life.

Oropharyngeal swallow in younger and older women: videofluoroscopic analysis

Much of the initial research on normal swallowing has been conducted in young men. Recently, there has been increasing interest in determining whether there are differences between the sexes in swallowing function and in the effects of aging on swallowing in both sexes. This investigation examined the swallowing ability of 8 healthy young women between the ages of 21 and 29 and 8 healthy older women between the ages of 80 and 93 during two swallows each of 1 ml and 10 ml liquid boluses. Videofluoroscopic studies of these swallows were reviewed in slow motion and real time to confirm the absence of swallowing disorders. Kinematic analysis of each swallow was completed. Data on range of motion of pharyngeal structures and coordination characteristics of the oropharyngeal swallow were taken from this kinematic analysis. Position of the larynx at rest and length of neck were compared between the two groups. Data from this study were compared with previously published data on younger and older men. Interestingly, the range of motion of the older women was often greater than that of the young women. Only tongue base movement diminished significantly with age in women. Volume effects observed in duration and extent of movement during the 1 ml and 10 ml swallows were similar to those in earlier studies. Older women also exhibited an increased range of motion relative to the old men. This increase may indicate a compensation for aging effects not seen in older men.

Vocal intensity characteristics in normal and elderly speakers

The relationship of lung pressure, fundamental frequency, peak airflow, open quotient, and maximal flow declination rate to vocal intensity for a normal speaking, young male control group and an elderly male group was investigated. The control group consisted of 17 healthy male subjects with a mean age of 30 years and the elderly group consisted of 11 healthy male subjects with a mean age of 77 years. Data were collected at three levels of vocal intensity: soft, comfortable, and loud, corresponding to 25%, 50%, and 75% of dynamic range, respectively. Phonational threshold pressure and lung pressure were obtained using the intraoral technique. The oral airflow waveform was inverse filtered to provide an approximation to the glottal airflow waveform from which measures of fundamental frequency, peak airflow, open quotient, and maximal flow declination rate were determined. Excess lung pressure was calculated as lung pressure minus estimated phonational threshold pressure. The results show for both groups an increase in sound pressure level across the conditions, with corresponding increases in lung pressure, excess lung pressure, fundamental frequency, peak airflow, and maximal flow declination rate. Open quotient decreased with increasing vocal intensity. Lung pressure, sound pressure level, and peak airflow were all found to be significantly greater for the control group than for the elderly group at each condition. Open quotient was found to be significantly lower in the control group than in the elderly group at each condition. No significant difference was observed for excess lung pressure, phonational threshold pressure, fundamental frequency, or maximal flow declination rate between the two groups. These results show that a difference in vocal intensity does exist between young and elderly voices and that this difference is the result of differences in lung pressure, peak airflow, and open quotient.

Control of vocal loudness in young and old adults

This study examined the effect of aging on respiratory and laryngeal mechanisms involved in vocal loudness control. Simultaneous measures of subglottal pressure and electromyographic (EMG) activity from the thyroarytenoid (TA), lateral cricoarytenoid (LCA), and cricothyroid (CT) muscles were investigated in young and old individuals while they attempted to phonate at three loudness levels, "soft," "comfortable," and "loud." Voice sound pressure level (SPL) and fundamental frequency (F ) measures were also obtained. Across loudness conditions, subglottal pressure levels were similar for both age groups. Laryngeal EMG measures tended to be lower and more variable for old compared with young individuals. These differences were most apparent for the TA muscle. Finally, across the three loudness conditions, the old individuals generated SPLs that were lower overall than those produced by the young individuals but modulated loudness levels in a manner similar to that of the young subjects. These findings suggest that the laryngeal mechanism may be more affected than the respiratory system in these old individuals and that these changes may affect vocal loudness levels.

Discharge characteristics of laryngeal single motor units during phonation in young and older adults and in persons with parkinson disease

Discharge characteristics of laryngeal single motor units during phonation in young and older adults, and in persons with Parkinson disease. The rate and variability of the firing of single motor units in the laryngeal muscles of young and older nondisordered humans and people with idiopathic Parkinson disease (IPD) were determined during steady phonation and other laryngeal behaviors. Typical firing rates during phonation were approximately 24 s/s. The highest rate observed, during a cough, was 50 s/s. Decreases in the rate and increases in the variability of motor unit firing were observed in the thyroarytenoid muscle of older and IPD male subjects but not female subjects. These gender-specific age-related changes may relate to differential effects of aging on the male and female voice characteristics. The range and typical firing rates of laryngeal motor units were similar to those reported for other human skeletal muscles, so we conclude that human laryngeal muscles are probably no faster, in terms of their contraction speed, than other human skeletal muscles. Interspike interval (ISI) variability during steady phonation was quite low, however, with average CV of approximately 10%, with a range of 5 to 30%. These values appear to be lower than typical values of the CV of firing reported in three studies of limb muscles of humans. We suggest therefore that low ISI variability is a special although not unique property of laryngeal muscles compared with other muscles of the body. This conceivably could be the result of less synaptic "noise" in the laryngeal motoneurons, perhaps as a result of suppression of local reflex inputs to these motoneurons during phonation.