Puberphonia

Meghan Moynahan
Voice Disorders
April 17, 2003
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
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
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
Reasons Puberphonia
Occurs…continued
 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
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
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
Voice Therapy…continued
 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
Half-Swallow Boom…continued
 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
Questionable Technique…Half-
Swallow Boom
 Pannbacker(2001) finds Boone and McFarlane’s 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
Questionable
Technique…continued
 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
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
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/webtherapy/falsetto.htm