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Puberphonia

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

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Puberphonia

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  1. Puberphonia Meghan Moynahan Voice Disorders April 17, 2003

  2. 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

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. Voice Therapy…continued • Lowering the larynx to an appropriate position • Humming while sliding down the scale

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

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