A lot of bodily changes occur in adolescence during puberty. When the body undergoes physical and psychological development, one of the transitions that happens is a change in one’s voice. In other words, in males the voice lowers about one octave and in females it goes down by one to three semitones. When this change in voice does not take place during this transitional period, it is known to be puberphonia (functional falsetto).
Also known as functional falsetto or mutational falsetto, puberphonia is observed more in males than females when the voice is unusually high-pitched beyond puberty.
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In males, there is a sudden increase in the length of the vocal cords as the Adam’s apple enlarges. This development is uncommon in females. The increase in vocal cords’ size is linked with growth in testosterone levels in pubescent males.
“The larynx, also known as the voice box, houses the vocal cords and it manipulates pitch and volume required for phonation,” said Bakul Parulkar, consulting audiologist & speech and voice therapist, Jaslok Hospital & Research Centre, Mumbai.
“When you speak, your voice is produced,” he said. “The air is forcibly moved through our throat and vocal cords. Our mouth and tongue play a part in forming words, but it is our pair of vocal cords that influence how deep or how high the tone of our voice is. For example, if you have ever plucked a small, thin rubber band, you would have heard the high-pitched twang it makes when it’s stretched. A thicker rubber band makes a deeper, lower-pitched twang. It’s the same sort of thing with vocal cords.”
Symptoms of puberphonia
“It isn’t difficult to identify if the person who has this voice disorder. There are five symptoms to identify it for immediate understanding and to consult either an audiologist or an ear, nose and throat (ENT) specialist,” said Dr Almas Vakil, an Ahmedabad-based otorhinolaryngologist (a doctor who specializes in problems of the head and neck).
These symptoms are as follows:
- High-pitched voice
- Low intensity
- Neck and throat tension
- Breaks in phonation and frequency
How common is functional falsetto ?
Such cases are low in number, 1 in 9,00,000 people, according to a study conducted by the department of ENT and head and neck surgery, Dr Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, Krishna district, Andhra Pradesh, and published in the International Journal of Phonosurgery & Laryngology on the subject.
“Even though the incidence is low, for the individual it causes a social and psychological embarrassment,” the study says. The reasons for puberphonia include emotional stress, delayed development of secondary sexual characters, maternal protection, psychogenic, hero worship of older boys, etc.
“To determine puberphonia, a complete voice assessment — including medical and diagnostic evaluations — is required. These assessments are performed by otorhinolaryngologists and speech-language pathologists and voice therapists,” said Parulkar.
In such a case, an ENT doctor must be consulted first. The doctor may refer the person to a speech therapist. Such a problem is generally addressed by a team of ENT specialists as well as speech and voice therapists.
Typically, the voice of an adult male has a fundamental frequency in the range of 85 to 180 hertz, and that of an adult female from 165 to 255 hertz. By contrast, in functional falsetto, the range is 200 to 250 hertz in adult males.
“Puberphonia being a mutational disorder, speech therapy has been considered as the mainstay of treatment. Of late, many surgical techniques have been tried with some amount of success. The first report of surgical treatment of puberphonia was in 2001,” according to a research article.
A 2006 research article favours the use of speech therapy. “This also requires repeated training with a speech therapist, which is time-consuming. The other treatment available is digital laryngeal manipulation, in which thyroid cartilage is being compressed, and the patient is asked to speak. Later, the patient is taught to repeat this procedure at home to sustain the male voice. This again needs a lot of patient encouragement and follow-up,” says the article by Sudhakar Vaidya and G. Vyas.
Parulkar says traditional voice therapy is ineffective in a few cases and that is when surgical interventions are considered. It is only when there is a delay in course correction or treatment or the condition becomes resistant to voice therapy that this line of treatment is suggested.
Dr Vakil told Happiest Health that functional falsetto does not go away or fade on its own. If a specialist is not consulted or early intervention or treatment is not opted for, the changes in the voice can remain throughout the individual’s life, he says.