Ask the Doctors: Vocal changes are common as we age

Dear Doctors: My chorus has started meeting again — outdoors and vaccinated — to practice and sing. We’ve had a year off, and I’m upset my voice is getting to be hoarse, and even cracking on low notes. I’m 67 and have always been a good singer. Is this from disuse?

Dear Reader: You’ve reached an age when many begin to notice changes to their voices.

This is often due to the physical effects of aging that can affect the vocal apparatus directly or arise from an individual’s health.

The changes that occur in the larynx, where the voice originates, are known as presbylaryngis, also called vocal fold atrophy.

The more general vocal changes that occur with age are called presbyphonia, also referred to as “aging voice.”

The larynx, or voice box, is a tubular structure in the neck that’s above the trachea, or windpipe, and plays a crucial role in breathing and swallowing. It also houses the vocal cords or vocal folds. These are two bands of smooth muscle tissue, wrapped in a mucuslike covering, that stretch across the top of the windpipe.

The vocal folds open to allow breathing and close while swallowing. This keeps the contents of the mouth from entering the lungs.

When we make any sound, the vocal folds draw close together and form a slit. As air from the lungs is forced through the slit, it creates suction that sets the outer layer of the vocal folds to vibrating.

This wave generates the sounds that, shaped by muscular movements in and around the larynx and after a complex journey through structures in the neck and face, we recognize as voice.

To produce a clear tone, the vocal folds must remain strong, moist and flexible and must be able to vibrate in symmetry.

As people age, the larynx can become stiff, and the vocal folds can lose tone, elasticity and moisture. This is known as vocal fold atrophy.

It interferes with the precise actions and positioning of the vocal folds that are needed for clean and clear vocal tones. This can result in thin, rough or hoarse tones as well as the cracking voice you’re experiencing.

Age-related changes to the body, such as decreased lung capacity and loss of strength and muscle tone, can result in a voice that is high, thin, breathy, shaky or reedy. A loss of volume ands vocal fatigue also are common.

Because hoarseness can be a symptom of an underlying health condition, check with your health care provider.

Dr. Eve Glazier and Dr. Elizabeth Ko are internists at UCLA Health.