The human voice is unique in the entire animal kingdom. The flexibility of the human voice allows us to portray our thoughts, emotions, joys, and fears. This extraordinary flexibility can be seen throughout life, beginning with the power of a baby’s cry to the wonderful fullness and range of the world-class soprano or tenor. Each voice is unique and provides one of the signatures of the individual. The ancient Greeks felt that the voice was so important to a person’s character that they thought that the voice actually originated in the heart.
These remarkable qualities of the voice are unfortunately not immune to the effects of human aging. It is rare that elite singers will continue to perform their most difficult roles even into their late 50s or 60s. As people enter their 80s and 90s, voices lose not only their range but also some of their strength and power, and male and female voices become less distinguishable.
Voice Changes Ignored?
A new study sheds light on a menopause symptom that is often ignored: A woman's voice often deepens over the years. For some women it is not a big deal, but for other it might become a great source of emotional distress, and even professional difficulties if the profession is related to signing or voice presentations. Berit Schneider, MD, a speech pathologist at the University of Vienna in Austria, noted, "Some women have minimal discomfort, but others complain of moderate or even severe problems". In previous studies, women have complained of lower pitch, a deeper singing voice, inability to hit the highest notes, and more hoarseness. However, few researchers have linked these changes with menopause symptoms.
In the latest study, Schneider and colleagues assessed the vocal quality of 107 women between ages 37 and 71 -- all postmenopausal. Each was asked about vocal changes and discomfort; each had tests of their speaking and singing voices.
Of this group, 46% mentioned vocal changes; one-third of them also had vocal discomfort; 54% reported no changes in their voice nor vocal discomfort.
Voice changes mentioned:
* Throat dryness
* Frequent throat clearing
* Lower voice frequency level
* Increased roughness and hoarseness
Of the 49 women with vocal problems, 10 were taking hormone replacement therapy (HRT) -- although eight of those were taking low-dose HRT. Nearly all had thick mucous on their vocal chords, evidence of a hormonal imbalance.
In doctors' offices, women talk about hot flashes, heart palpitations, and vaginal dryness problems -- but voice changes are rarely discussed, writes Schneider. However, an increasing number of women between ages 40 and 60 complain of vocal problems.
These findings make sense because various body tissues rely on the presence of the hormone estrogen to stay healthy (estrogen dependent), the authors writes. Menopausal women often suffer from dryness and thinning of many body tissues because of loss of collagen and muscles mass -- which likely affects the vocal chords. Smoking likely intensifies this problem, since it causes earlier menopause -- and because it deactivates estrogen.
Reason for Changes
During the perimenopause, ovarian activity strongly diminishes. Progesterone and estrogen levels are dramatically reduced. Similarly, the secretion of male hormones also drops off considerably. But their presence, now that they are no longer counterbalanced by feminine hormones, can sometimes cause the voice to become more masculine. Thus, the ovary becomes a simple endocrine gland with no reproductive function.
The menopausal phase normally lasts from the age of 47 to the age of 55. The impact that the sex hormones had on their various target organs disappears, not without consequences. However, these days, the administration of substitute hormones enables the unpleasant consequences of this lack of sex hormones to be delayed to an increasingly later age, saving many women from a trying experience that is both mentally and physically hard to accept. Our better understanding of endocrinology has provided therapies that may help some menopausal woman to have a better quality of life.
In some cases, hormone substitutes may be a contraindication. They are not recommended in cases of breast cancer, in patients with a high-risk family background, in certain cardiovascular pathologies, or in cholesterolrelated afflictions. For this reason, a medical check-up is a prerequisite for women in their 50s considering their options.
Because estrogens are reduced, the receptors of sex hormones receive more androgens and become more receptive to them. As a result, the vocal cord mucous membrane thickens and exhibits a lack of tonicity and a deficiency of contour. The voice becomes deeper and more masculine. Meanwhile, the 60-year-old woman may develop symptoms such as increased hairiness, as an indirect consequence of androgens. A smear test of the cervix of the uterus indicates an atrophy of the epithelium. The same result is obtained from a smear test of the vocal cords: the parallelism is amazing.
Since 1977, we know that in both men and women fat cells can turn androgens into estrogens. The relationship between obesity and a higher secretion of estrones (estrogen derivatives) is also age related. It is higher in menopausal women. This is the work of a specific gene in our DNA (cytochrome 19 associated with P450 aromatase) that facilitates the transformation of androgen into estrogen in our adipose cells. Thus, the lower need for hormone substitutes of overweight woman is caused by the fact that her fat cells will transform her androgens into estrones. Meanwhile, the slim woman is more likely to need hormone substitute therapy, although the positive value of lower weight for many chronic diseases such as hypertension and diabetes would seem to be more important to most women.
With age, muscle mass also diminishes, adipose mass increases, and cells are redistributed differently about the body. Corticosteroids encourage the increase of fat cells. Therefore, menopause women need to be cautious about consuming them. A carefully considered hormone substitute therapy program, associated with vitamins and minerals, can bring considerable benefits to most females who have elite voice requirements, if their body can tolerate it. Many women thus treated are able to avoid developing a masculine voice as they age and are able to preserve a beautiful voice for significantly longer. It is impressive to see the sopranos who have kept the same tessitura until the age of 65.
As the menopausal woman advances in age, her new hormonal balance, with its absence of estrogens and its very mild secretion of testosterone due to the atrophy of her ovaries, is no longer able to sustain the tonicity and strength of the vocal cord muscles. What are the consequences of this? The two vocal cords atrophy progressively. The mucous membrane covering them becomes thinner and dehydrates.
Initially, the voice displays a narrower register, the higher harmonics are lost, and the voice is less powerful and tires faster. However, a paradoxical effect sets in. Because the vocal cord has diminished in thickness and become finer, the voice, which had become a little deeper, now becomes higher, more delicate, sometimes even shrill. You often hear 80-year-olds speaking with a very high-pitched voice. One can thicken the vocal cords again by injecting a substance into them, which may provide some reasonable timbre and vocal endurance.
Voice Therapy Helps
Indeed, "for most [menopausal] women [who come to my clinic], the No. 1 complaint is voice discomfort or fatigue -- it takes a lot more effort to talk," says Edie Hapner, MD, speech pathologist at the Emory Voice Center in Atlanta.
Tissue dryness is a primary menopause symptom, and it can affect vocal chords. "When the vocal fold tissue dries, it takes more respiration effort to make it vibrate," she says. "That respiratory effort over time contributes to vocal fatigue -- you're working harder to use your voice."
Correct vocalization can minimize the negative effects of menopause just as exercise of any other part of the body can help an individual in shape during the aging process. The emotional frustration can be overwhelming, so working with singers during this process can be psychologically challenging. Not only do these singers need a lot of psychological support, but also solid vocal tools that assist in recovering from the vocal confusion caused by hormonal changes. Alan Lindquest once made a comparison between menopause and the changing boy's voice because both situations deal with major hormonal changes in the body. These changes demand drastic adjustments in how the voice is to be vocalized.
Preserving a Youthful Voice: A Multifactorial Treatment
The key to preserving a youthful voice is to be serious about physical exercise, hydration, lubrication of the vocal cords, dental hygiene, muscular activity, nutrition, vitamin and mineral supplements, possibly appropriate hormone therapy, and, often, anti-reflux medication. The multiple potential etiologies of a voice problem in the aging patient may make specific identification and treatment difficult, because the disorder may be related to a number of different factors.
In general, people who are conscientious about their overall health will maintain good care of the health of their vocal cords. For the average person this should help to maintain a strong and vibrant voice. For the performer, they can most certainly retain an efficient vocal tessitura and timbre.
Hormonal treatment may be used. Thyroid testing may find a deficiency in thyroid hormones, more commonly found in women, which should be treated.
Many patients who are unhappy with the quality of their voices may benefit from voice therapy. Some will prefer or add singing lessons and join a choir to strengthen their voices. This also allows them to belong to a team, to talk to others, and to routinely practice their voice.
Some will require an acute treatment for arthrosis (anti-inflammatory medicine or injection of steroid in the cricoarytenoid joint), or injection of material in the bowing vocal cord. Dental care is important to maintain good oral hygiene and lubrication. In some cases, respiratory therapy may be valuable in improving the breath support of the voice.
Alternative medicine with vitamins, minerals, and antioxidants may not only play an important role in overall health but also in vocal health. Lubrication of the vocal tract is critical to optimizing voice quality. This can be accomplished through hydration and at times the use of mucous thinning medications (mucolytics).
If people do not take proper care of themselves, the voice will age. The vocal register will narrow, the voice will weaken, and the timbre will lose color and become metallic. This may be partially avoided by adopting a regular and constant healthy lifestyle, by taking antioxidants, vitamin C and E, minerals such as magnesium, and by keeping up physical and intellectual activities.
In sum, the human voice is not immune to the effects of aging. Vocal quality and strength can be affected by a number of different conditions that increase in prevalence with age. The memory and the activity of the brain are indispensable to keep a good voice. As time goes by, the register becomes narrow, and the brain command is slower due to loss of neurons. Training the voice and developing vocal memory are important in sustaining a strong voice with age. Fortunately, with appropriate diagnosis and environmental and hygienic interventions, specific medical treatments, and voice therapy, most people can maintain a functional, quality voice through all of their lives.
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