Voice Changes Throughout Life There are several major factors that affect voice classification as a person ages:

growth, especially changes in vocal fold length development of the cricothyroid and thyroarytenoid muscles changing structure of vocal fold tissues ossification of the cartilage in the larynx These factors affect the voice throughout life, beginning with childhood, and proceeding through puberty and adulthood to advanced age. Childhood During childhood, the most significant changes in the voice result from the rapid growth of the larynx, the vocal folds and the surrounding support structures. At birth, the membranous length of the vocal folds (the part that actually vibrates) is around 2 mm males and females. Here's an illustration to show the difference between the membranous length (shown as Lm) and total vocal fold length (Lm + Lc, where Lc is the cartilagenous length):

For the first 20 years or so of life, the growth rate is approximately 0.7 mm per year for males, and 0.4 mm per year for females, which results in a maximum adult length of about 16 mm for men, 10 mm for women. This growth of the vocal folds causes Fo to drop as predicted by the equation below:

Since children have smaller lungs and smaller vocal folds, we might expect children to be quieter than adults, but as anyone who has heard a screaming baby knows, this isn't the case. Children can produce sounds as loud as adults despite their smaller apparatus, because higher Fo's guarantee higher intensity. Also, lung pressure is 50-60% higher for children than adults, so children also make up for their smaller size by working harder vocally. Adolescence For adolescents, the big vocal changes occur during puberty, especially in men. The male hormone testosterone causes many significant changes to the male voice, including faster growth of the larynx than in women, along with increases in the size and thickness of the vocal folds themselves. Having longer folds of course decreases the Fo for males, and the thicker folds produce a register change - a change in the quality or timbre of the voice. Adolescent boys' voices often begin to mutate at 12-13 years of age and taper between 15-18. During this time, lower pitches tend to be more stable than upper pitch ranges, and most of the active changes tend to occur within one year. Female pubertal voice changes are often less obvious than that of males. However, adolescent girls' voices tend to exhibit increased breathiness or huskiness, occasional "cracking", a lowering of average speaking fundamental frequency, and increased pitch inaccuracy while singing. The physiologic components that account for voice changes include facial development (related to voice resonance), a descent of the larynx (effectively lengthening the vocal tract), and increased circumference of chest wall and lung (providing greater breathing capacity). Adulthood and Advanced Age Perhaps the voice change that has been investigated most is pitch level. Speaking changes from young adulthood to old age, but the pattern differs according to gender. In women, F0 remains fairly constant until menopause, when a drop occurs (approximately 10 Hz -15 Hz). This drop presumably results from hormonal changes that cause thickening and edema of the laryngeal mucosa. In men, F0 lowers approximately 10 Hz from young adulthood to middle age. The reason for this drop is unclear. After middle age, F0 in men rises substantially (approximately 35 Hz) into advanced old age, reaching the highest level of adulthood. In elderly males, changes in the cricoarytenoid joint may affect function by lessening vocal fold approximation, or reducing the smoothness of vocal fold adjustments during phonation. Glandular changes may cause drying of epithelium, which may increase stiffness of vocal cord cover. Increased cover stiffness could increase instability of vocal fold vibration and raise fundamental frequency (F0) in elderly men. Some investigators report progressive thickening of the epithelium with aging in both sexes. In males, thickening reportedly is progressive up to age 70, with declines

thereafter. In females, thickening is described as progressive, particularly after age 70. Thickening of the laryngeal epithelium may contribute to lowering of F0 or to increased harshness of voice. The respiratory system changes from young adulthood to old age. In lung tissue, loss of elasticity is considered the most significant change. Other respiratory system changes include stiffening of the thorax and weakening of respiratory muscles. These changes alter lung volumes and respiratory mechanics. While total lung volume remains unchanged in the elderly, vital capacity decreases and residual volume increases. Maximum expiratory flow rate is decreased and lung pressure is decreased. Thus, elderly speakers experience a decline in the amount of air they can move in and out of the lungs and in the efficiency with which they move air. The larynx also undergoes age-related anatomic changes during adulthood. Many of the changes are more extensive in males, including ossification and calcification of laryngeal cartilages, atrophy and degeneration of intrinsic muscles, deterioration of cricoarytenoid joint, degeneration of glands in the laryngeal mucosa, degenerative changes in the lamina propria, and degenerative changes in conus elasticus. As various muscles and connective tissue in the vocal folds atrophy or degenerate with age, it can become more difficult to make the voice perform normally. Since the thyroarytenoid muscle helps to control pitch, intensity and register, any loss of function in that muscle will have an adverse effect on vocal performance. Some cells become dystrophic with age and no longer perform their normal tasks. Muscle fibers lose their ability to obey nerve impulses telling them to contract. Nerve cells lose the ability to transmit neural signals properly. As a result, the voice may become weak or fluttery. Edema or swelling of the vocal fold cover interferes with the normal vibration of the folds, which can lower the voice, or cause roughness. In elderly males, changes in the cricoarytenoid joint may affect function by lessening vocal fold approximation, or reducing the smoothness of vocal fold adjustments during phonation. Glandular changes may cause drying of epithelium, which may increase stiffness of vocal cord cover. Increased cover stiffness could increase instability of vocal fold vibration and raise fundamental frequency (F0) in elderly men. Atrophy vocal cord

The vocal folds seem thinner and less plump. The cartilages are more starkly outlined, and in particular, the vocal process (a point of the arytenoid cartilage at the back of the

vocal fold) may stand out. Occasionally, this is mistaken for a mass, like a polyp or a cyst. Normal projections of cartilage (arrows) appear to stand out as abnormal masses in these thinned vocal folds.

During voicing, the vocal fold edges do not come together in the middle because they have lost bulk. This produces a gap between the vocal folds in the shape of a spindle. Thinned vocal folds are not able to close completely during voicing, and leave a characteristic spindle-shaped gap.