Indian Journal of Otolaryngology and Head and Neck Surgery Vol. 58, No. 1, January-March 2006

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Main Article

ABSTRACT: Puberphonia affects the adolescent males. Authors have used a novel approach by using

a Macintosh laryngoscope for stretching of vocal cords, which gives immediate and permanent relief.

This procedure, which was incidentally found to be useful, while doing a laryngoscopic examination of apuberphonic patient, was effective and superior to any method used in the past. 26 cases treated during

1991 to 2005 had been followed with the excellent results.

Key Words: Puberphonia, Laryngoscopy, speech therapy

PUBERPHONIA: A NOVEL APPROACH TO TREATMENT

Sudhakar Vaidya*, G. Vyas**

*Associate Professor (Otorhinolaryngology), **Professor (Medicine), R. D. Gardi Medical College and Ujjain Charitable Trust Hospital, Ujjain, (MP),India

INTRODUCTIONPersistence of adolescent voice after puberty is known aspuberphonia, especially in absence of any organic causes. Thecondition is most commonly seen in males, who continue touse high pitched voice even after puberty, occasionally it isencountered in females who use high pitched voice. Theincidence of puberphonia in general population is 1 in900,000. (Bannerjee and others 1995).[1]

In infantile larynx, the laryngotracheal complex lies at a higherlevel than in adulthood. The laryngotracheal complexdescends throughout the life, but at puberty there is rapidlowering of larynx relative to base of tongue.[2] The largerlarynx means longer cords and deeper pitch. The boy maycontinue to use high-pitched voice or it may break into higherand lower pitch. The larynx is larger and unstable and thebrain is more accustomed to infant voice. At the puberty itwill need to retrain in order to cope with larger larynx.Aetiology of puberphonia include emotional stress, delayeddevelopment of secondary sexual characters, psychogenic,hero worship of older boy, maternal protection etc.Puberphonia may also be because of non-fusion of thyroidlaminae, in these cases hypogonadism may be the cause andit has to be ruled out.[3]

Present treatment for puberphonia is voice therapy andpsychological counseling.[4-10] This requires facility of speechtherapist and it is time consuming.

MATERIAL AND METHODSThis method had been used since 1991 and more than 26patients had been successfully treated using this method. The

study included 26 consecutive patients between the ages of14 to 20 years (all males) diagnosed clinically as cases ofpuberphonia from 1991 to August 2005. Secondary causes ofvoice changes including hypogonadism were excluded forthe study. Consent from the patient’s guardian was obtainedbefore the procedure. Patient was asked to come nil by mouthfor six hours before the procedure in the ENT outdoor. Patientwas examined under xylocaine spray anesthesia byanesthesiologist’s intubation laryngoscope (Macintosh). Longblade of laryngoscope was put in valleculae and patient wasasked to speak a long eeeee. Pressure over the valleculaestretched the vocal cords. Sometimes-additional pressure wasapplied by a laryngeal biopsy forceps over the anteriorcommisure. The external digital pressure over the thyroidcartilage also helped in improvement of the voice quality.The procedure was repeated 3-4 times in a single sitting.

RESULTSThere were 26 males in the study between ages ranging 14 to20 years. In all patients procedure was done under localanesthesia. Patients having other aetiologies for change invoice had been excluded from the study. After laryngealstretching with intubation laryngoscope there was immediateimprovement in the voice quality from child pitch to malepitch. Patients were followed for 3 months fortnightly and 3patients required repetition of procedure after 3 months, outof which one didn’t improve and had been sent to speechtherapist and psychological evaluation.

DISCUSSIONPresently treatment for puberphonia is voice or speech therapy,which requires a consultation with speech therapist, which is

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not available in many cities of India. This also requiresrepeated training with speech therapist, which is timeconsuming.

The other treatment available is digital laryngealmanipulation, in which thyroid cartilage is being compressed,and patient is asked to speak. Later on, patient is taught torepeat this procedure at home to sustain male voice.[11] Thisagain need a lot of patient encouragement and follow up. Nocorrective surgical procedure is available except Pau andMurty (2001), who has reported first case of surgicalcorrection of puberphonia by mobilization of hyoid andsuperior halves of thyroid cartilage and reducing cricothyroiddistance by apposing mobile hyoid to fixed cricoid cartilageby 2 non-absorbable figure of eight sutures.[12]

The method reported by the authors was incidentally foundto be useful, while doing direct laryngoscopic examinationof a patient of puberphonia. No reference is available exceptfrom Dr M Kumerasan (Chennai), who has published his workin book “A research work in Otorhinolaryngology” in 1992.He used rush-miller (USA) laryngoscope and treated 11patients up to publication of his research paper.[13]

ACKNOWLEDGMENTAuthor is grateful to Dr. V. K. Mahadik, Medical Director, R.D. Gardi Medical

College and Ujjain Charitable Trust Hospital Ujjain (MP) for giving

permission to publish this research paper and for the encouragement and

support.

REFERENCES1. Banerjee AB, Eajlen D, Meohurst R, Murty GE. Puberphonia –A

Treatable Entity (abstract), 1 World Voice Congress Oporto: Portugal;

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2. Tucker HM. The Larynx. 2 edn. New York: Thieme; 1992

3. Aronson AE. Clinical Voice Disorders. 2 edn. New York: Thieme

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4. Boone DR, Macfarlane SC. The Voice and Voice therapy. 6 edn. Boston:

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5. Carding PN, Harsley IA, Docherty GJ. A study of effectiveness of voice

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6. Case J. Clinical Management of Voice Disorders. 3rd edn. Austin: Pro–

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7. Colton RH, Casper JK. Understanding Voice Problems: A Physiological

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13. Kumaresan M. Clinical and Practical Otorhinolaryngology: A Research

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Address for CorrespondanceDr. Sudhakar VaidyaD3/2, Dhanvantari Nagar,Near Birla Hospital, Ujjain, MP, IndiaE-mail: drsvaidya@hotmail.com

Puberphonia (A novel approach to treatment)