Puberphonia

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Puberphonia

• Meghan Moynahan
• Voice Disorders
• April 17, 2003

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What is Puberphonia?

• Unusual high pitch that persists beyond puberty
• Other symptoms?hoarseness, breathiness, pitch
  breaks, inadequate resonance, shallow breathing,
  muscle tension, lack of variability
• Common complaints are inability to shout or
  compete with background noise and vocal fatigue
• A.K.A- falsetto, 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

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Who experiences Puberphonia?

• Postpubescent males due to inability of pitch to
  lower
• Individuals with hearing impairment due to poor
  auditory feedback
• Adult men and women

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Reasons Puberphonia Occurs

• 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

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Reasons Puberphonia Occurscontinued

• Current researchers feel that the more likely
  cause is an attempt to control unstable pitch and
  quality characteristics
• High pitched voice characterized by puberphonia
  is caused by increased tension and contraction of
  the muscles in the larynx causing it to elevate

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Goals for Puberphonia

• Teach the patient to phonate at a low pitch by
  showing him how to use his phonatory and
  respiratory musculature to its full capacity
• Demonstrate that the new low-pitch is to be used
  and avoid the old high-pitch
• The SLP should see that the patient is
  comfortable with his new voice through
  encouragement and help him use it in different
  situations

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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

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Voice Therapycontinued

• Lowering the larynx to an appropriate position
• Humming while sliding down the scale

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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

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Half-Swallow Boomcontinued

• 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

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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

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Questionable TechniqueHalf-Swallow Boom

• Pannbacker(2001) finds Boone and McFarlanes
  half-swallow boom is not effective
• Can be physiologically impossible to swallow and
  say boom at the same time
• Can induce vocal hyperfunction and damage to
  vocal folds which can increase the risk of
  worsening a voice problem
• This can cause an iatrogenic voice problem?one
  that is caused or worsened by actions of the
  clinician

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Questionable Techniquecontinued

• No empirical evidence that this technique is
  effective
• Pannbacker trying to say that all effort closure
  techniques should be used in moderation because
  of the damage they can cause

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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
  patients new voice is stabilized

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References

• Boone, D.R. McFarlane, S.C. (2000). The Voice
  and Voice Therapy. Englewood Cliffs, New Jersey
  Prentice Hall
• Pannbacker, M. (2001) Half-Swallow Boom Does it
  Really Happen? American Journal Of
  Speech-Language Pathology, 10, 17-18.
• Stemple, J.C.,Glaze L.E. Klaben, B.G. (2000)
  Clinical Voice Pathology Theory and Management.
  San Diego, California Singular Publishing Group
• Wilson, D.K. (1987). Voice Problems of Children,
  Third Edition. Baltimore, Maryland Waverly Press
  Inc.
• Falsetto. Retrieved on March 25, 2003, from
  University of North Carolina Voice Disorders
  Website
• http//www.unc.edu/chooper/classes/voice/webther
  apy/falsetto.htm