A reader recently wrote in, “Dear Editor: I would like Dr. Jahn to write an article about aging of a voice that has always been used in a healthy technique and repertoire. My laryngologist told me I must really know how to sing because my cords looked so well used and still have full range—but I am not happy with it all the same. I can’t pull out those arias the way I used to.”
This is a dilemma that most singers will eventually face. You have spent your entire musical life studying, singing the right repertoire, cultivating healthy professional and personal habits—and now the voice is changing. And your doctor looked at your vocal folds and told you that the folds look fine! How can this be?
Let’s first deal with the practical aspects and analyze the examination. We have come to depend (I would say excessively) on the visual examination of the larynx. The doctor puts a laryngoscope in through your nose or mouth, projects the image on a TV screen, and examines it. This may be either straight video or laryngeal stroboscopy. Both examinations—indeed, any bodily function tests—are limited by the method of examination. So, if there is a discrepancy between test results and clinical reality, I say we need to test the test!
Specifically, in the case of videolaryngoscopy, we are looking at a two-dimensional, electronically generated still image of a three-dimensional structure that vibrates in a rapid and complex fashion. The color of the folds, an important visual cue to health, is artificially reproduced and may or may not reflect the true color. Fine degrees of difference, both in color or shape, may fall below the limits of resolution of the video laryngoscope.
You need also to realize that video stroboscopy does not really show the movement of the vocal folds in real time. It is an optical illusion: like a movie, it captures a series of still images and projects them in sequence. But unlike a movie, it is not a real-time record of vocal fold vibration. Stroboscopy samples thousands of repetitive movements and captures an image at a certain point in movement. If the rate of projection is slightly out of phase with the rate of vibration, an illusion of motion is created.
The validity of stroboscopy in depicting vocal fold function depends on the assumption that every vibration is exactly the same and that sampling thousands of identical vibrations is equivalent to seeing the folds move in real time. But this is not so! There are minute differences between cycles, which we cannot see with this equipment. Ultra high-speed photography of the vocal folds is a real “movie” that depicts every vibration, including minute differences from one to the next. This equipment, however, is not practical, and you would need a computer to make sense of the massive amount of information generated. And then you would still need to put the results in context of the patient’s clinical complaints.
My point with all of this is simply that a visual structural examination in the office, no matter how state-of-the-art, can give only a small amount of information about a complex bodily function. The test may look perfect, but as a diagnostic tool, it is limited by its limitations.
Apart from how your vocal folds look, there are many other parameters that can cause vocal deterioration—parameters that are invisible (such as hormonal or nutritional status and your genetic inheritance)—all of which have an effect on aging. The aging of the voice is a complex phenomenon and not a simple representation of how your vocal folds look. Muscle mass and function in the lungs, larynx, and supraglottic vocal tract; structural flexibility of the joints; neuromuscular coordination; changes in the brain and the nerves—these are all critical and, importantly, are not routinely measured. Even if we could measure all of these (and other yet undetermined) parameters, we could not track them in real time as you sing.
But let’s assume we could identify every parameter and generate measurements for norms and then for abnormal vocal behavior. Even with all that, you cannot stop the gradual deterioration that comes with aging. Aging is an inevitable reality, although how rapidly we age and how aging manifests vocally vary from one person to another. I have many singer patients in their 80s who are still getting paid for singing: a remarkable achievement and a happy confluence of right thought, right mind, right action—and right genes. The art, then, becomes to continue to sing, to generate beautiful sounds with an instrument that must inevitably diminish in power and flexibility. To convey an epic poem with a haiku: that is the real art.
So please don’t be discouraged by the dilemma of good-looking vocal folds vs. difficulties in singing. I hope you will understand that the voice is infinitely more complex than a video image on a screen. Your voice is dynamic and it changes continually throughout life. Keep exploring, reinventing, and making maximal use of the instrument that you have now. Someone once said, the key to wisdom is acceptance. Accept your voice and enjoy the pleasures it can give you today.
