BodyRuby : Adulthood

How Does Our Voice Ages? The Science of Vocal Chord Aging and How to Make Best Diagnosis.

Learn how your voice changes from adolescence to old age, why it happens?

Our voice is a beautiful instrument of the body that helps us communicate with others. It not only allows us to talk but also lets us explain how we feel, how healthy we are, and even who we are. Our voices change and grow with us, from the happy laughs of a child to the wise words of old age. They tell a story of our lives without a single written word.

Even though this change is normal, many people find it unsettling when the voice they’ve known for decades starts to sound different. So, understanding this change can give us strength by showing us the complex ways in which our physical health and ability to speak are connected.

So, let’s read together to understand these changes and how to cope with them.

The Science of Vocals


To understand the vocal changes, we first need to know how our voice box works.

Like many other systems in the body, the specific sound of a speaking voice is the result of many anatomical variables. To make them easy, we will divide them into parts,

  • Lungs: The lungs provide the flow of air needed to make a sound. They give the voice power by pushing air and vibrating the vocal chord through the throat.
  • The Vocal Chords: Two muscles make up the vocal folds. Together, they form a stretchy curtain that opens and closes in the trachea (the tube that carries air through the throat). The closed vocal folds vibrate when air from the lungs passes through them, creating sound. We can effortlessly change notes and pitch as we speak by changing the length and tightness of the vocal folds by pushing more air.
  • The Resonators: The resonators in the throat, mouth, and nasal passageways enhance and shape the sound that the vocal folds create. The size and form of these resonators affect the voice.
  • The Articulators: The tongue, lips, teeth, and palate are articulators that form sounds into understandable speech.

So, by moving the laryngeal muscles between the cartilages, we can stretch those folds and contract them to play our internal instruments intuitively. Rapid and minor changes in the folds produce high-pitched, quiet tones, while slow and large vibrations produce deep, bellowing rumbles. These processes remain the same from the first to the last word. But as we age, the laryngeal muscles can change and age, too.

Voice Changes During Lifetime

Our voice experiences many changes during its lifetime. Some are very prominent, while some are not. Some of the most prominent

Voice Changes During Puberty

When it comes to voice, there isn’t much difference between male and female voice cords before puberty. We know puberty as sexual maturation. Secondary sexual characters also emerge, which occurs between the ages of 10 and 14 for girls and 12 to 16 for boys. During this time, both sexes experience vocal instability and adjustment, although the changes are more noticeable in males. Such as.


A boy hitting puberty might experience some voice “breaks” as his testosterone levels skyrocket. This causes the larynx and vocal folds to enlarge, thicken, and elongate. It can also cause a small laryngeal protrusion called Adam’s apple. In men, this increase in size is about 16 mm (0.63 in).

Another change that occurs in the vocal cords during puberty is when the homogenous tissue covering the folds forms its own three layers. The muscle layer is in the middle, the layer of collagen is wrapped in stretchy elastic fibers, and the third is the mucous membrane layer on the outside. This gives the speech more depth and subtlety. It also gives it a unique timber tone that is different from its pre-pubescent tone.

All these changes provide them with more space to vibrate, and the end effect is a deeper voice, characteristic of a male entering puberty. The process can be sudden, and the voice may crackle as it goes from a higher to a lower tone before it settles down.


Vocal changes affect young girls as well, but the effects are relatively less. The thinning of vocal cords occurs and makes it 20-30% and the larynx makes the young woman’s voice richer and more feminine as a result. The enlargement of Adam’s apples is 10 mm (0.39 in). In this context, estrogen and progesterone have a function, gently affecting the stability and quality of the voice.

Time Period of Vocal Prime

During the early years of maturity, which usually fall between the late teens and late twenties, the voice is at its most powerful, resilient, and versatile, also called the Vocal prime.

The vocal system is at its strongest at this stage of growth, letting the person fully control volume, tone, and pitch. Being able to sing is easy at this point because the voice is strong and clear.

As for women, their hormones continue to influence their voices even beyond adolescence. The ovulatory phase of a woman’s menstrual cycle is associated with the highest quality of her voice, although it can sound different during other stages of the cycle as well. The reason is that the glands unleash their full mucus production at this stage, allowing the voice cords to perform at their peak.

The Middle Age Vocal Changes

Very minute but subtle changes start to show themselves when people approach middle age. Overuse or abuse of the voice, environmental factors, and the aging process all contribute to the gradual onset of vocal problems. A few changes that science tells us include,

  • Voice Fatigue: There is a higher chance of vocal fatigue; the voice may become tired more quickly after extended usage.
  • Loss of Elasticity: The voice becomes less flexible as the vocal folds gradually lose part of their elasticity. The range may be reduced and the tone may be somewhat altered as a result of this.
  • Lifestyle and health factors: These changes can be worsened by things like smoking, not drinking enough water, and acid reflux, among other things, which can make the changes in voice quality more evident.

Vocal cords get older, just like almost every other part of the body. But some people may not notice these changes. 

Voice Changes During Aging

We now understand that the voice may undergo certain changes throughout puberty, which sudden cracks or squeaks might indicate. But as time goes on and one becomes older, many people could feel the difference in the voice, too.

Age-related vocal changes are called prebyphonia. 

One word for the alterations that happen to a person’s voice as they get older is presbyphonia. It occurs in adults over 60 due to a combination of factors, including the natural aging process and the overall effects on our lifestyle and the environment. These changes are,

Vocal Cord Atrophy

Fig 3 Thinned vocal folds are not able to close completely during voicing and leave a
Thinned vocal folds are not able to close completely during voicing.

Like our muscles, the vocal chord also undergoes atrophy, also known as prebylaryngis. Thinning, shrinkage, and bending of the vocal cord inward characterize this condition in the vocal cords. The result is a weaker, breathier voice. Loss of volume and clarity in speech is another possible symptom.

Reduced Lung capacity

The strength of our breathing muscles weakens with age, making it harder to hold long words and keep your voice loud. This results in shorter phrases, and sometimes, harder speaking may result from reduced respiratory efficiency. It can also cause people to put more power into speaking and later withdraw from social situations.

Changes in Pitch

Changes in pitch are another hallmark of aging vocal chords. The pitch may go up a little for men as their voice folds lose mass and tension. On the other hand, women may experience a lower pitch, which may be a result of menopause-related hormone changes. Men and women may also notice a drop in speaking volume, which can make it harder to be heard in noisy places.

Changes in the Supraglottic Vocal Tract 

The muscles in the face and the tissues in the mouth lose their flexibility as we get older. As people age, their teeth also change shape. Last but not least, less salivary flow and production causes dry mouth, oral pain, and trouble swallowing.

Unlike some physical signs of aging, like muscle loss, not all people will develop this condition, as it has been reported to be severe in 25%- 30% of people only. Presbyphonia is rarely dangerous, although it can affect a person’s communication skills and, in extreme circumstances, their general health.

Causes of Changes in Voice

Science suggests that these changes are mainly due to,

  • Aging Vocal Mechanism: Aging may cause a loss of flexibility in the voice mechanism. The laryngeal joints may stiffen, and the cartilage may calcify. The voice chords may lose muscular tone, flexibility, and suppleness and become dry. Sometimes, the laryngeal muscles atrophy, becoming thinner and weaker. The ribs may become more calcified. The size of your body may decrease, while your lungs may grow smaller, stiffer, and less flexible.
  • A decline in General health conditions: The changes in some other health conditions can also be the reason which may increase the aging voice. These include body fatigue, or nerve problems that can make the voice shake or tremble. Normal (nodules, polyps), malignant (cancer) growths, or the effects of age-related conditions like reflux or Parkinson’s disease.can also change the voice or cause one of the vocal folds to become less efficient.

Common Signs of an Aging Voice

The following are a few most observed symptoms of an aging voice:

  • Less projective voice or a thin voice also known as vocal asthenia
  • Noticeably trembling voice. The voice might sound shaky.
  • The breathy or weaker tone of voice
  • Speech may worsen towards the end of the day, referred to as vocal fatigue
  • Cough reflex while speaking due to vocal dryness
  • The signs of vocal fatigue, to the point where the voice cuts off mid-use
  • Difficulty projecting the voice in gathering or noisier environments

The symptoms and indicators of presbyphonia might differ from person to person. Rather than appearing suddenly, most symptoms tend to develop over time. Most of these changes become most noticeable when they sing or raise their voice.

Examining Vocal Changes

If vocal changes start bothering or discomforting someone, they should consult an ENT specialist. The doctor will then do a comprehensive evaluation of the vocal cords and throat. This examination is the initial step in dealing with the discomfort of an aged voice.

Medical Evaluation

The laryngologist will assess any medical history, including surgeries or recent illnesses, that may be influencing the voice changes. The doctor will also examine any changes in the rest of the neck and head.

Vocal changes are observed by 30% of adults above the age 50

Video laryngoscopy

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Image Source:

Video laryngoscopy is a comprehensive visual examination that allows doctors to assess the vibratory patterns of the vocal cords as an adult talks. The doctor will spray the nasal area of the person undergoing the examination with a topical anesthetic to make them more comfortable throughout the brief examination, which lasts for around one minute.

Then, to examine the voice box and vocal cords, doctors insert a small camera called an endoscope through the nasal passages. With the help of a strobe light, a visual can be seen on the monitor to access the movements. This examination allows us to see any physical issues that could be causing the voice difficulty, such as lesions, stiffness, paralysis, erratic motions, strain on the throat, or inadequate closure of the vocal cords caused by thinning.

However, the voice procedure that the vocal cords produce in the case of presbyphonia would be the same. However, vocal cords might have atrophy of the muscle, which makes it hard for them to close their vocal cords tightly. This problem with the vocal cords makes the voice weak and breathy and also tired.

Voice Testing

In many severe cases, voice testing may also be employed. These tests look at things like pitch, volume, and quality. Some of these tests are acoustic analysis, which checks how the voice sounds, and wind testing, which checks how air moves and presses on the vocal cords while speaking.

As medical and healthcare technology advances, older adults are also becoming aware of possible vocal changes in them. The good news is that we can find strategies to maintain our powerful and audible voices even as we become older. Our upcoming post will cover treatments, simple vocal exercises, and voice care suggestions. Even as we age, these measures can significantly improve the quality and tone of our voices.

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Dr Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.
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