1. Meghan Moynahan Voice Disorders April 17, 2003
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
Puberphonia is a psychogenic voice disorder; Researchers find that there may be a number of reasons this disorder occurs
Embarrassment of the new voice makes them hold on to their old one especially if it occurs before the rest of their peers

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
Boone McFarlane find that therapy begins with the cough…coughing produces the male’s adult voice
Boone McFarlane speech range masking next technique oral reading on tenth word masking is introduced
Hooper patient breathes in, build air pressure w/o letting air put posture the vowel, vowel is released
Visi-Pitch visually represents pitch levels

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
Half swallow boom is recommended for unilateral v.f. paralysis, bowing of the v.f. or falsetto
States that all effort closure techniques should be used sparingly and cautiously
Boone and McFarlane state that effective in a case with unilateral vocal fold paralysis but in the clinical trials there was no sign of benefit and an increase in hoarseness was noted
Pannbacker states that there is a need for more data to determine whether or not it is effective
Boone and McFarlane do not suggest to use the half swallow boom for falsetto in the 2000 edition of their book

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,
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: