Example of vocal cord atrophy/aging voice.Vocal fold atrophy, also often called "aging voice" or "presbyphonia," is a voice condition characterized by thinning of the vocal fold muscles and tissues. This loss of muscle bulk often results in a curved appearance that prevents the vocal folds from closing normally when speaking or singing. Other surrounding laryngeal muscles may squeeze more tightly to compensate for the reduced vocal fold closure.

Causes of Aging Voice

The primary cause of vocal fold atrophy is aging. The larynx (voice box) and vocal fold muscles age just like the muscles in the rest of the body.  Just as we all age differently, the degree and severity of age-related changes to the vocal folds vary from person to person. In other cases, people may develop vocal fold atrophy as a consequence of a nerve injury. Some people are simply born with thinner vocal fold muscles than others.

Vocal Fold Atropy Symptoms 

In general, vocal fold atrophy may result in a “weak” or quiet voice that is effortful or fatiguing to use. Some patients experience pitch changes, hoarseness, or roughness in vocal quality. In more significant cases, patients report a sensation of “running out of air” when speaking. Other symptoms may include throat clearing or difficulty swallowing. 

Diagnosis of Vocal Cord Atrophy

Our voice care team at the Voice and Swallowing Center has the advanced training and skills necessary to diagnose this voice condition. During the initial visit, you will be assessed by one of our laryngologists and likely, an additional session with one of our voice pathologists. We use cutting-edge diagnostic tests to determine the cause of your voice disorder and to develop your plan of care. Following a thorough discussion of your symptoms and medical history, be expected to undergo the following assessments: 

  • Video Laryngostroboscopy: Using a small camera inserted through the nose or mouth, our specialists are able to assess the health and function of your larynx (voice box) and assess for structural or functional changes associated with aging (curvature along the length of the vocal folds and incomplete closure of the vocal folds during voicing tasks). Click the link to learn more. 

  • Perceptual, Acoustic, and Aerodynamic Voice Evaluation: This is a comprehensive assessment of multiple voice parameters completed by the voice pathologist. Click the link to learn more. 

Non-Surgical Treatment for Aging Voice

Treatment for vocal fold atrophy varies depending on the degree of vocal fold thinning and the severity of the patient’s symptoms/how the voice changes impact activities of daily living. Vocal fold atrophy may result in very mild symptoms and in some cases, patients prefer observation only without pursuing treatment. 

If your voice condition affects your activities of daily living and quality of life, you may be evaluated by one of our voice pathologists to determine your candidacy for voice therapy. There is no way to restore muscle bulk and tone with exercise. However, voice therapy with special attention to efficient and healthy voice use may resolve or significantly reduce voice symptoms due to vocal fold atrophy. In other cases, voice therapy may need to be combined with surgical treatment (i.e. before surgery, after surgery, or both). However, in some cases a combination of surgery and voice therapy may not lead to voice improvement.  

Surgical Treatment for Aging Voice

In more severe cases of vocal fold atrophy which do not respond to voice therapy, surgical intervention is offered. Surgical options consist of procedures that attempt to assist in closing the gap between the vocal folds during voicing. We offer laryngeal framework surgery, which includes placement of a vocal fold implant(s) through a window in the thyroid cartilage, in-office vocal fold injection augmentation, which involves injecting a temporary filler into the vocal fold(s), or vocal fold fat injection augmentation, an injection of your own fat into the vocal fold(s). Your laryngologist with help you choose the best procedure for you as each option has its own advantages and disadvantages. These procedures often significantly improve the voice, and in some cases, voice therapy may also be recommended pre- and/or post-operatively.