Human Voice
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.
Aging Voice
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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