Transcription:
Aging Voice Disorders

Melanie Cole (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family.

Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And here to talk about aging voice disorders is Dr. Lucian Sulica. He's a Sean Parker Professor of Laryngology at New York Presbyterian Weill Cornell Medical Center, and the director of the Sean Parker Institute for the Voice at Weill Cornell Medical College.

Dr. Sulica, it is a pleasure to have you with us today. As somebody in the voice world, as somebody who does this for a living and talks, I'd like to ask you how this field of voice medicine has really evolved over the years. It's really a newer field, but it's evolved so much.

Dr Lucian Sulica: Thanks, Melanie. I'm very happy to be here. The emphasis in laryngology has really changed with the development of technologies that allow us to look better at the vocal folds. Thirty or forty years ago, the medical attention to the larynx was pretty much about lumps or bumps. You know, is there a lump? Is there a bump? Biopsy it, remove it. And now, really, we're focused so much more on function, so much more on voice quality, supporting people's jobs or social ambitions or even their hobbies. It's really become a functional endeavor.

Melanie Cole (Host): It certainly has. It's a fascinating field to me, and people that are in radio and podcasting, singers, which are really the elite athletes of your field. What are some of the voice and vocal problems that can occur due to aging or overuse? As an exercise physiologist, Dr. Sulica, I see overuse injuries, right? But you do too. So, tell us a little bit about what you see as a result of aging and the kinds of conditions you encounter.

Dr Lucian Sulica: Well, there's a vast number of conditions that can affect the vocal chords and the larynx, but when we're restricting it to aging, I would divide it into two categories. First of all, there are tissue changes that are related to age in and of itself. In other words, not necessarily disease, but aspects of aging that affect the vocal chords and their function and therefore voice quality. And then second of all, there are range of medical conditions which generally affect the elderly more than they affect younger people. And they can certainly affect the larynx and the vocal chords as well.

Melanie Cole (Host): Tell us about the services. We're going to get into some of these types of treatments and the conditions we're talking about, but I'd like you to tell us a little bit more about the Sean Parker Institute for the Voice, the services and treatments. Tell us about this. It's so interesting to me.

Dr Lucian Sulica: Well, the Sean Parker Institute was conceived as a center where we could take patients walking in the door with a voice complaint all the way to walking out the door in good voice, recovered, healed, and back to doing whatever they wanted to do with their voice.

So, the Sean Parker Institute has physicians who have the latest technology to evaluate the vocal folds. These physicians are all fellowship-trained laryngologists. That is to say they're ear, nose, and throat doctors that have had additional training in laryngology. We've got speech-language pathologists. The speech-language pathologists are the behavioral specialists. They are a subset of speech language pathologists that concern themselves exclusively with the voice, and they help patients decipher behaviors and learn about behaviors that can improve voice.

In addition, we have all kinds of technology that allow us to accomplish in the office what we had to go to the operating room to do before. We've moved, I would say, 70% of our surgical cases out of the operating room and into the office, and we have those resources at the institute too. So, we're really pushing the edge on evaluation, on treatment, not just surgical treatment, behavioral and surgical treatment of all aspects of voice disorders.

Melanie Cole (Host): So then, tell us about some of those age-related vocal chord changes that could include a loss of volume or bowing of the vocal chord inner edges. You know, tell us about those particular conditions that are kind of specific to aging.

Dr Lucian Sulica: Absolutely. And not only that, but they're gendered too. So, men and women age very, very differently. Typically, as men age, they tend to lose muscle mass. So much of our muscle mass is supported by testosterone. As testosterone levels sort of decrease, the muscle mass decreases. The vocal folds -- the vocal folds and chords are synonymous terms by the way -- are basically two shelves of muscle that are in the windpipe and that act to produce sound. When they get thin, they don't meet very well. And as a result, the voice loses power, loses clarity, becomes effortful. So, that's the typical sort of creaky old man voice that you might imagine. And that's a big hindrance, especially because among the elderly, partners and friends may be getting hard of hearing. And more and more older people are staying in the workplace, so they need to function at a level that they didn't necessarily need to function at before.

Melanie Cole (Host): What are some of the symptoms? You mentioned the old man voice. Is this something that comes on over time? Is it something that we notice right away? I start to notice little hoarseness, maybe then it goes away. So, tell us what would send us to see whether it's our primary care provider or then to see a laryngologist, which is such a specialized field.

Dr Lucian Sulica: Well, in general terms, I would say that any voice change that doesn't resolve on its own, even if you're young, needs to be looked at after about two weeks. I mean, everybody's allowed to get hoarse if they have an upper respiratory infection or something like that. And we all know what to do in those cases. You rest your voice a little bit, you hydrate, you rest, your voice should bounce back. If that doesn't happen over the course of two weeks, somebody needs to take a look at those vocal folds.

Melanie Cole (Host): Tell us a little bit about some of those things that we're doing to our voices, the risk for these voice disorders, which could increase our risk as we age. What are we doing to ourselves?

Dr Lucian Sulica: Well, when you produce voice, you are making your vocal folds vibrate at an amazingly fast rate. For example, when you speak, each vocal fold is vibrating around 200 cycles per second to minimum and potentially higher. That's basically mechanical stress on some pretty delicate tissue. And the damage that can be caused by that has to do with sheering forces and collisional forces between the two vocal folds. There are a whole range of lumps and bumps on the vocal folds and scar and other lesions that can result from this mechanical stress.

Because the aging voice is a little less efficient than it was in the younger patient, you typically have to blow more air against them, which increases the risk of injury. So, it's not a markedly different risk. It's just slightly increased from the regular patient. Particularly as older people are trying to stay in the workplace and stay involved, I can tell you just from my own experience, that I have a cadra of college professors, litigators, who are still arguing court cases and people like that who are finding that their voice is really not reliable in old age, and these are the people who seek care.

Melanie Cole (Host): I hear you there. That's me, and I have been in vocal therapy myself. So, I'd like you to speak about treatments. What kind of interventions are available to reduce the impact, such as vocal hygiene programs or vocal therapy? And, by the way, how do I sound?

Dr Lucian Sulica: You sound great. You sound great.

Melanie Cole (Host): Oh, that's good.

Dr Lucian Sulica: Yeah. The treatments fall into three categories. There are medical treatments that are reserved for things like infection and swelling that happen fairly acutely. Those are probably the least used in this patient population. There are behavioral treatments, and that's analogous to physical therapy for a sports injury or a joint injury. And the behavioral treatments aim at conditioning, at building self-awareness, at teaching hygiene. We leave these to the speech-language pathologists. They're the specialists in this.

Then, there are surgical treatments. We can actually change the configuration of the vocal folds in various ways to counteract some of the changes of aging. Now, older patients typically have medical problems, so we certainly don't rush to surgical interventions. But often, people can't achieve the level of voice that they want with just behavioral management alone. So, there are surgical options.

Melanie Cole (Host): And you really work as a multidisciplinary team, yes? I mean, as you mentioned, speech pathology, and so you all have to work together. If you want to give us a little brief overview of some of those surgical options and what you do, what you can do for people.

Dr Lucian Sulica: Well, I talked about if you want male pattern aging voice, right? And that has to do with thinning of the vocal folds. There are various surgeries available to rebulk the vocal folds. Some of these are temporary, some of them are permanent. Some can be done in the office and some need a trip to the operating room. But typically, they're really quite effective as long as you've got the diagnosis correct.

Melanie Cole (Host): I would like for you to offer your best advice to listeners, to me, to anybody who is getting up there in years who is hearing this podcast and saying, "Okay. But what can we do to help ourselves along the line?" Are there some tried and true home remedies? Is air quality involved? How much water we drink? Spoonful of honey? Is there anything we can do to strengthen our vocal chords and/or protect them as we go through life?

Dr Lucian Sulica: There are all kinds of approaches to these types of problems. Essentially, it's about hydration and budgeting your voices. So if you hear your voice getting strained, if it starts feeling uncomfortable, if the voice quality starts to get a little rough, your instinct should be for voice rest.

In terms of hydration, there's all kinds of magic formulas about how much water you should drink. If you drink some of these, you know, 12 glasses of water a day type things, you're going to spend most of your day looking for a restroom. I don't know that you necessarily need to hydrate that aggressively, but you do need to make sure that you've got enough water on board to lubricate the system. Beyond that, honey, tea, apple cider vinegar, these are all things that are out there, not very well supported medically, and I'm sort of skeptical.

Melanie Cole (Host): Well then, wrap it up for us. What would you like us to know about aging voice disorders and the Sean Parker Institute for the Voice? And really just your best advice because our voice is, for some of us, are our careers. But as we get older, we certainly want to be able to communicate and be heard, and so give us your best advice.

Dr Lucian Sulica: You know, voice is a critical body function that people take for granted. I think from my point of view, the last thing I want is a patient to accept a limitation because of their voice. I want patients to feel like they have a recourse if they find their voice limiting them. So, I would say that if your voice is limiting you, see somebody, don't just accept it.

My best advice in terms of preserving vocal health is stay in the game. Don't give up because something doesn't work the way it used to. Very often there are things that we can do, there are things that you can do, there are things that a speech-language pathologist can do to improve matters and keep you functioning your best.

Melanie Cole (Host): What an informative podcast. Excellent information. Dr. Sulica, thank you so much for joining us today. And you can get more information on aging voice disorders at weicornell.org/seanparkerinstituteforthevoice.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine.

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