Treatments offer elderly something to shout about

THE term "voice lift" was coined by Dr Robert Sataloff in 2004 to describe the techniques used to repair a damaged or ageing voice. Sataloff, professor and chairman of the ear, nose and throat department at Drexel University College of Medicine, in Philadelphia, gives an exaggerated sigh when I ask if he regrets inventing the phrase.

"I haven't thought of a better term," he says, "but I have certainly spent more time than I would like, explaining that it's not just like dropping in and having an operation like a facelift. It's complex and requires a multidisciplinary approach."

Recent newspaper reports in Britain have highlighted growing interest in "voice lift" treatments, which can include the use of fat or fillers usually employed in cosmetic procedures.

Yakubu Karagama, an ENT consultant and head of the voice clinic at Manchester Royal Infirmary, thinks demand for such procedures will increase. "We have an ageing population who are working longer, and I think people will have it done because they are struggling in the workplace. I would rather people think of it as a functional, not a cosmetic, thing."

Thinning of vocal folds is part of the ageing process and this is what causes the voice to sound breathy, says John Rubin, a consultant surgeon at the Royal National Throat, Nose and Ear Hospital, in north London.

"The first thing we do is send the patient to our speech therapist and we also get them involved in gentle exercise. Often that is enough to make the voice sound younger and more fit. If that doesn't work satisfactorily, then we may suggest a little augmentation."

This usually involves taking fat from the stomach and injecting it into the vocal folds, although substances such as collagen can be used. "It effectively makes them thicker and allows them to have better contact," Rubin says.

He says he treats very few people who are concerned with ageing: "We treat many more people who come to us with vocal cord paralysis or damage," though he too suspects demand will increase.

In the US, where the treatment is more common, Sataloff says there has been a "huge increase" in the number of older people seeking voice rejuvenation.

"As people age, they have real quality of life problems - their voices are getting softer and breathier, while all their friends are going deaf," he says. "It becomes harder for people to have conversations or interact ..."

Sataloff also points out that, sad for us as a society, we are quick to judge people by their voices, and older people can fall victim to this.

"As people's voices become unsteady, they become less convincing to us," he says.

"So, older people, who are often the most experienced and wise, have voices that begin to sound infirm and people unconsciously infer that those people are infirm and their spoken opinions don't have the weight they should."

Those worried by vocal ageing start coming to him in their 50s, he says, though most common are people in their 60s and 70s. The majority worry about how their voice is affecting their career.

"Business people, clergy, lawyers, politicians, secretaries. There are also people who are retired but don't want to sound like an old woman or man, want to be able to sing in the retirement community choir, want to be able to have conversations with people without yelling," he says.

Surgery, he says, is the last option - but filler injections are a temporary measure, he also offers tiny implants made from silicon or Gore-Tex.

"That's why 'voice lift' confuses people. It's actually a complex package of activities that include establishing an accurate medical diagnosis, and exercises with a team of voice specialists to improve or eliminate some of the changes."

This, Sataloff says, can take "decades off the sound of the voice. More than 80 per cent of the time, people are satisfied without having to resort to surgery."