The voice is affected by many factors, and one of them is the age of the person. The proportion of the elderly population is increasing worldwide, and older people often experience changes such as vocal fatigue, tremor, changes in tone, a shortened maximum phonation time and hoarseness. Ageing brings a decrease in the muscle strength required for voice production, especially in the vocal cords (vocal folds) and the surrounding tissues, together with reduced respiratory capacity and lung flexibility.
The voice can also be affected by many medications used for systemic and local diseases. Polypharmacy is quite common in the elderly population. Medications can have direct and indirect effects on laryngeal lubrication, the mucosal integrity of the vocal cords, laryngeal muscle function and laryngeal sensation. These effects may be mild at first and increase over time.
In the elderly population, decreased vocal intensity and projection, easy fatigue, tremor, a higher pitch in men and a lower pitch in women, a rough or breathy voice, a shortened maximum phonation time, difficulty swallowing and hoarseness may all be observed. The following groups of medications can have particularly negative effects on the voice:
- Muscle relaxants
- Antidepressants
- Diuretics
- Antihypertensives
- Anticholinergics
- Vitamins, in high doses
- Oral birth control pills
- Oestrogen replacement therapy after menopause
- Inadequate thyroid replacement medication
- Anticoagulants (blood thinners)
- Herbal medicines or supplements
One of the most common side effects of some medicines is hoarseness. Inhaled steroids, such as those used for asthma, can cause hoarseness.
Anticoagulants (blood thinners) can increase the risk of haematomas and oedema. Excessive tension in the vocal cords can cause bleeding, which sets the stage for oedema and haematoma. This can lead to hoarseness and a rough voice.
Muscle relaxants can contribute to acid reflux through relaxation of the muscles around the oesophageal junction, and throat reflux can directly irritate the throat and vocal cords. Antihistamines (allergy medications), diuretics (water pills), decongestants, antidepressants and the alpha-blockers used for benign prostatic hyperplasia can cause laryngeal dryness accompanied by voice fatigue and dysphonia.
Antipsychotics, tranquilisers and anticonvulsants (epilepsy medications) can alter the function of the oral and pharyngeal muscles and lead to delayed laryngeal or oesophageal dyskinesia, dysarthria or tremor. Some antidepressants can cause side effects such as speech disorders or indistinct speech.
Induction of bilateral vocal cord paralysis with stridor has also been associated with these types of drugs. Speech sensitivity and oropharyngeal ataxia can also be induced by these drugs. Severe dry mouth is a common side effect of many selective serotonin reuptake inhibitors and has been described at a much higher rate with serotonin norepinephrine reuptake inhibitors. Alpha1-adrenergic blockers may also be associated with significant dry mouth in many patients.
A thorough examination of the relationship between voice complaints and the start of drug therapy is important for identifying the adverse effects of drugs on the voice. Consultation with a specialist experienced in voice disorders is therefore recommended to achieve the best vocal outcomes.
