Puberphonia

adolescent transitional
voice disorder
mutational falsetto
 What is Puberphonia?
• Unusual high pitch that persists beyond puberty
• Failure to change from high pitched voice of
preadolescent to lower pitched voice of adolescent and
adult
• This high pitched falsetto type voice is weak thin
breathy, hoarse and monopitched , giving over all
impression of immaturity
• Common complaints are inability to shout or compete
with background noise and vocal fatigue
• mutational falsetto, pubescent falsetto, incomplete
mutation, persistent falsetto, adolescent transitional
dysphonia
• Males are said to have mutational falsetto; females
are said to have childlike or juvenile voice
 Reasons Puberphonia
Occurs

• Most probably sychogenic

• Embarrassment of the “new” voice
• Failure of a male to accept their adult role
• Over identification of a male with his mother
• Social Immaturity
• Desire to maintain soprano singing voice
• Muscle incoordination/dysfunction with no
known etiology
• High pitched voice characterized by puberphonia
is caused by increased tension and contraction of
the muscles in the larynx causing it to elevate
 Natural history
• Normally at puberty the voice drops
by an octave in boys, but only 3 to4
semitone in girls .in boys, the
transition takes from 18 months to 3
years at is usually completed by the
age of 14.
• This voice change in puberty is
accompanied by pitch instability and
register breaks, the voice appear to
be too high in pitch for the
individual’s age and sex and is often
described as “never broken”
• The voice often momentarily deeper on
nonphonatory tasks ,such as laughing or
coughing and his is the key indicator of the
condition. Even if it is recognized that the
individual has too voice ; higher and lower
pitched, the latter is not perceived, as
their voice is abnormal so consequently not
used.
• The voice can tire and be effortful to
produce on shouting or when projected.
Occasionally some patients experience pain
and discomfort in the supralaryngeal
region due to elevated position of larynx.
There is often some associated
psychological distress as the boys ridiculed
and taunted because of their abnormal
voice and inferred effeminacy
 pathophysiology
• In puberphonia , the larynx tends to
be held high in the neck, thereby
shortening of vocal tract. The cricoid
cartilage is usually tilted backward
and vocal folds remain too lax and
limited in their ability to adjust to
demands in change in tension and
vibrational frequency.
• The vocal folds are stretched and
thin with minimal mucosal waves. The
cricothyroid remain excessively
contracted .
1. The larynx is elevated high in the neck.
2. The body of the larynx tilted downward,
apparently, having the effect of
maintaining cords in lax state.
3. With the vocal cords in flabby state ,
they are streched thin by contraction of
cricothyroid muscle.
4. Thus, the vocal cords are in state of
reduced mass and offer little resistance
to infraglottic air pressure.
5. Respiration for speech production is
shallow, and on exhalation infraglotic air
pressure held to a minimum, so only the
medial age of the cords vibrate
producing high frequency sound
• Its important to exclude organic
conditions such as endocrinological
abnormalities vergeture and scarring.
• Although most who present are keen to
improve their voice, those are attend at
behest of family and friends and who are
not concerned by their voice generally
have poor prognosis regarding resolution.
 treatment

• The treatment of choice is voice

therapy, although occasionally
botulinum toxin injections to
cricothyroid muscle have been shown
to be effective in resistant cases.
 Voice Therapy for
Puberphonia
• Cough
• Speech-range masking
• Glottal Attack before a vowel
• Relaxation techniques to reduce tension of the
larynx
• Visi-Pitch
• Digital manipulation of the thyroid cartilage while
producing a vowel
• Lowering the larynx to an appropriate position
• Humming while sliding down the scale
 Half-Swallow Boom
Technique
• Ask client to swallow, and as this action is still
in progress, say “boom”
• Let the client produce “boom” in a low pitched
voice
• Ask the client to say “boom” louder and with
less breathiness
• Have the client discriminate between the
normal production from the “boom” production
with help of tape recorded samples
• Teach the client to turn the head first to one side and
to the other and say “boom” each time
• Lower the chin while saying boom
• Ask the client to add sounds and words to “boom”
( boom /i/, boom one)
• Teach the client to add phrases and sentences
• Fade out the boom and swallow
• Ask the client to lift the chin up and bring the head
back to the midline as he or she produces normal
speech
 Why Half-Swallow Boom
is believed to work…
• The swallow procedure maximizes closure of the
larynx
• “Boom” is a single word composed of voiced sounds
that is able to be produced as air is released from
the constricted larynx and the oral opening is
minimized
• Produces posterior pressure on the larynx
• Boone and McFarlane believe this technique is a
slow progression to get the pt. to lower their
pitch
 Voice Therapy as a
Whole
• Overall voice therapy is very promising
• Typical puberphonic patient produces a
functional lower pitch during the first
session
• Highly motivated to use their new voice
• Very rare that they need follow up therapy
or psychological counseling
• It is recommended to continue therapy
until the patient’s “new” voice is stabilized
• Lastly , laryngeal famework surgery
is contraindicated