Age-related changes in larynx can have a direct impact on voice quality and general comfort level. Observations of vocal aging have spanned perceptual, acoustic, aerodynamic, physical, electromyographic (EMG) and histological levels. Evidence of differential vocal aging in relation to gender and physical condition has been reported. Perceptual, acoustic, aerodynamic, kinematic, EMG and histological data document age-related changes in laryngeal structure and function with advancing age. These changes contribute to a functional age-related impact of vocal hypofunction or compensatory hyperfunction. This review will focus on the current understanding of the clinical and cellular changes in the larynx that lead to presbyphonia.