PUBERPHONIA
Puberphonia is a type of voice disorder that is defined by the regular use of a high-pitched voice after puberty.
- Puberphonia is characterized by an inability to transition into the lower pitched voice of adulthood.
- It is also referred to as functional falsetto or mutational falsetto.
- During puberty, a dramatic change happens to the laryngeal mechanism both in males and females resulting in a decrease in pitch.
- During this change, the male voice deepens or lowers about one octave and the female voice deepens or lowers by a few semitones.
- The average pitch of an adult male typically falls between 85 and 180Hz and an adult female falls between 165 and 255Hz.
- When this change does not occur or take place, an individual is said to have puberphonia.
- This occurs in both male and female but occurs more frequently in males.
CAUSES
The cause of the disorder may be both psychological (psychogenic) or biological in nature. However, biological causes are rare in male while the psychogenic causes are more prevalent.
Psychogenic causes may include:
- A delay in the development of secondary sex characteristics.
- Emotional stress
Biological causes may include:
- Incoordination of muscle
- Vocal fold asymmetries
- Muscle tension of the laryngeal
- Nonfusion of the thyroid laminae
- Congenital anomalies of the larynx
SYMPTOMS
- High pitch
- Shallow breathing
- Weak or hoarse voice
- Low intensity
- Throat and neck tension
- Pitch breaks
DIAGNOSIS AND TREATMENT
DIAGNOSIS
Patients will usually seek help as they get very uneasy with the disorder and its social implications. The speech pathologist will evaluate the voice, and vocal output habits.
TREATMENT
Treatment includes speech therapy(direct and indirect) and pyschotherapy.
For the direct therapy, the disorder is treated by using vocal exercises which are carried out by a speech-language pathologist (SLP) or a speech therapist with experience in treating voice disorders.
The treatment commonly lasts from one to weeks.
Techniques used include:
Humming while sliding down the scale: in this technique, the patient is asked to start humming at the highest pitch that can be reached and then keeps lowering the pitch as humming continues. This allows such patient to relax the laryngeal muscle and helps to practice the use of a lower pitch.
Cough: The patient coughs as pressure is applied to Adam’s apple. This results in the vocal folds been shortened. This is the physiological mechanism that reduces pitch.
Laryngeal musculature relaxation: A reduced pressure on the vocal folds is achieved when the laryngeal muscles that surround it are relaxed. This can be done by yawning and subsequently sighing, singing or speaking the “m” word, and by chewing while speaking.
Lowering of the larynx to appropriate position: when the larynx is lowered, the vocal folds are relaxed and thus pitch is lowered. This is done by the patient by applying pressure on Adam’s apple while speaking.
Boom technique: The patient says boom just after swallowing. The technique is repeated with the patient making a head turn to either side while the chin is also being lowered. This helps to completely close the vocal folds.
Indirect voice therapy treatment may include audiovisual feedback, pyschotherapy and surgery
Using an audiovisual feedback allows the patient to visualize and observe a graphic and numerical representation of their voice and pitch. The patient can then pick an ideal pitch range, work through speech tasks while working in that desired pitch range.
Surgical intervention can be considered in cases where voice exercises are ineffective. Different types of surgical procedures have been successful in people especially men with puberphonia. Relaxation thyroplasty is one of such surgical procedure.
This technique is designed to improve the voice by altering the thyroid cartilage in order to shorten the vocal folds. This helps in lowering the vocal pitch.
Pyschotherapy
Psychological counselling may also be performed. This is done by a psychologist or counsellor and can help the patient in identifying the psychological factors that contributes to the disorder. The psychologist then gives out tools or methos to help the patient address such factors.