Connective tissue changes in the larynx and their effects on voice

Abstract

Many characteristics of the aging voice have been described in the literature. These features include pitch changes (1-3), irregularities in vocal fold vibration (4), glottal incompetency as reflected in air loss and breathiness (5), and voice production changes associated with laryngeal tension, pitch breaks, roughness, hoarseness, and harshness (5-7). The evidence thus far obtained indicates that both male and female voices age; however, changes are most evident in the male (2,3). Although the precise reasons for the aging of voice are far from being well understood, they undoubtedly relate to the manner and extent that tissues change within the larynx. Data from acoustic, physiologic, and perceptual studies suggest that the nature of these intrinsic changes are complex and probably multifactorial. During the past 30 years there has been a modest amount of research on the biological aspects of aging of the voice; however, activity has increased significantly in the last 15 years. Most work has dealt with various aspects of changes in the connective tissues of the larynx including cartilages (8-12), ligaments (10,11,13,14), articular surfaces (15,16), and the lamina propria of the vocal folds (10,11,14). Unlike the long established research on aging of connective tissue in the body, for which there is a vast literature (17), relatively little is known about the aging of connective tissue in the larynx. Such information would be valuable in explaining some of the mechanisms of aging and the resultant physical and mechanical changes that occur as a result of the aging process. This paper reviews research on age-related con-