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Mutational Falsetto Mutational Falsetto Kristine Stanton What is Mutational Falsetto? | Mutational Falsetto: a post- adolescent male continuing to have a preadolescent voice (Stemple et al., 2000). | Juvenile Voice: a post-adolescent female having the vocal qualities of a child (Nicolasi et al., 2004). | AKA: Functional Falsetto, Puberphonia, Persistent Falsetto (Nicolasi et al., 2004). What kind of Voice Disorder is Mutational Falsetto? | Functional and | Psychogenic | Why??? z There are typically no physical anomalies z Often it is related to emotional or psychological factors Demographic | Male Dominance z Young men between age 11-15 (Dagli et al., 2008) z 1/900,000 men per year (Pau & Murty, 2001) | Juvenile Voice is very rare (Hedge, 2001) Signs and Symptoms | Increased pitch or fundamental frequency | Weak, breathy, hoarse voice | Pitch breaks | Low intensity (Dagli et al., 2008) | Psychological symptoms Etiology | Resisting change of puberty | Habitual pitch | Dislike new pitch after puberty z New pitch does not match personality | Want to remain young | More identification with females (Hedge, 2001) | Singing voice | Embarrassment (Stemple et al., 2000) | Anatomical differences (Lim et al., 2007) Diagnosis | Case History | Assessment of vocal quality and pitch | Laryngostroboscopy | Psychological Assessment Treatment of Mutational Falsetto Treatment Approach Author(s)/Year Subject(s) Method(s) Result(s) Validity Surgical Pau, H. & 24 year Surgical lowering of the 6 weeks post surgeryÆwent Clinical Case StudyÆ Murty, G.E., old male hyoidÆlowering of the larynx from 175Hz to 142Hz= no comparison studies 2001 successful surgical lowering available, first ever of pitch case of surgically corrected falsetto ??? Validity/EBP Laryngoscope Vaidya, S. & 26 males Pressure applied to valleculae Immediate improvement No statistical Procedure Vyas, G., 2006 Ages 14 to internally by laryngoscope and from child pitch to male information provided 20 years externally on thyroid cartilage pitch ??? Validity/EBP Voice Therapy Dagli, M., Sati, 44 males, Manual manipulation of larynx, All patients lowered p < 0.05 for all I., Acar, A., 1 female larynx depressing exercises, speaking voice to appropriate measures of voice= Stone, R.E., Ages 13 to vegetative voice (coughing, pitch for their age and gender statistically Dursun, G., 40 years yawning, etc) significant findings &Eryilmaz, A., 2008 Good Validity/EBP Voice Therapy Lim, J.Y., Lim, 15 males Manual compression of the larynx, Decrease in pitch from P<0.05 for most vocal S.E., Choi, S.H., Ages 15 to prolongation of phonation at a average of 193.41Hz to measures= Kim, J.H., Kim, 27 years lower pitch (syllables, words, 113.49Hz, improved vocal statistically K.M., & Choi, sentences, paragraphs, efficiency, no significant significant findings H.S., 2007 conversation) changes in the intensity of voice Good Validity/EBP Treatment Approach: Surgical | Surgery of the hyoid, thyroid cartilage, and larynx | Lowered hyoid and thyroid cartilage which subsequently lowered the larynx | Results=successful in lowering the pitch (Pau & Murty, 2001) Treatment Approach: Laryngoscope Procedure | Performed on 26 men successfully | Pressure applied to the valleculae with laryngoscope and digital manipulation of the thyroid cartilage | Results=immediate change from child voice to adult voice (Vaidya, S. & Vyas, G., 2006) Treatment Approach: Voice Therapy | Treatment hierarchy z Demonstrate appropriate pitch using Direct Vocal Manipulation (Stemple et al., 2000) z Allow client to hear difference in their habitual pitch and the lower pitch z Single phonemes, simple sounds, words, phrases, sentences, conversational level. z Train family | Treatment should be fast (Hedge, 2001) Voice Therapy: Direct Vocal Manipulation | Demonstrate appropriate pitch z Hard Glottal Attack z Lowering of the larynx | Stabilize new pitch using treatment hierarchy (Stemple et al., 2000) Voice Therapy: Manual Manipulation and Compression of the Larynx | Thyroid cartilage area is pressed downward with the fingers to hold the larynx down and prevent it from moving upward during phonation (Lim et al., 2007). | “Downward and dorsal pressure” on thyroid cartilage (Dagli et al., 2008) Validity/EBP of Treatment Treatment Approach Author(s)/Year Subject(s) Method(s) Result(s) Validity Surgical Pau, H. & 24 year old Surgical lowering of the 6 weeks post Clinical Case StudyÆ Murty, G.E., male hyoidÆlowering of the surgeryÆwent from 175Hz no comparison studies 2001 larynx to 142Hz= available, first ever case of successful surgical surgically corrected falsetto lowering of pitch ??? Validity/EBP Laryngoscope Vaidya, S. & 26 males Pressure applied to valleculae Immediate improvement No statistical information Procedure Vyas, G., 2006 Ages 14 to internally by laryngoscope from child pitch to male provided 20 years and externally on thyroid pitch cartilage ??? Validity/EBP Voice Therapy Dagli, M., Sati, 44 males, 1 Manual manipulation of All patients lowered p < 0.05 for all measures of I., Acar, A., female larynx, larynx depressing speaking voice to voice= statistically Stone, R.E., Ages 13 to exercises, vegetative voice appropriate pitch for their significant findings Dursun, G., 40 years (coughing, yawning, etc) age and gender &Eryilmaz, A., Good Validity/EBP 2008 Voice Therapy Lim, J.Y., Lim, 15 males Manual compression of the Decrease in pitch from P<0.05 for most vocal S.E., Choi, S.H., Ages 15 to larynx, prolongation of average of 193.41Hz to measures= Kim, J.H., Kim, 27 years phonation at a lower pitch 113.49Hz, improved vocal statistically significant K.M., & Choi, (syllables, words, sentences, efficiency, no significant findings H.S., 2007 paragraphs, conversation) changes in the intensity of voice Good Validity/EBP Research is Needed!!! | “a search of PubMed database revealed 8 articles published since 1983” (Dagli et al., 2008, p. 277) | Not often documented in case loads or research studies=difficult to study incidence and treatment (Dagli et al., 2008) | Available studies lack validity References Dagli, M., Sati, I., Acar, A., Stone, R.E., Dursun, G., & Eryilmaz, A. (2008). Mutational Falsetto: intervention outcomes in 45 patients. The Journal of Laryngology & Otology, 122, 277-281. Haynes, W. & Pindzola, R. (2004). Diagnosis and Evaluation in Speech Pathology, 6th Ed. Boston, MA: Pearson. Hedge, M.N. (2001). Introduction to Communicative Disorders, 3rd Ed. Austin, TX: Pro-Ed. Lim, J.Y., Lim, S.E., Choi, S.H., Kim, J.H., Kim, K.M., & Choi, H.S. (2007). Clinical Characteristics and voice analysis of patients with mutational dysphonia: clinical significance of diplophonia and closed quotients. Journal of Voice, 21, 12. Lundy, D.S. & Casiano, R.R. (1995). “Compensatory Falsetto”: Effects on Vocal Quality. Journal of Voice, 9, 439-442. Nicolosi, L., Harryman, E., & Kresheck, J. (2004). Terminology of Communication Disorders: Speech-Language-Hearing, 5th Ed. Baltimore, MD: Lippincott Williams & Wikins. Pau, H. & Murty, G.E. (2001). First case of surgically corrected puberphonia. The Journal of Laryngology & Otology,115, 60-61. Peppard, R.C. (1996). Management of Functional Voice Disorders in Adolescents. Language, Speech, and Hearing Services in Schools, 27, 257-270. Roth, F.P. & Worthington, C.K. (2005). Treatment Resource Manual: Speech Language Pathology, 3rd Ed. Clifton Park, NY: Thomson Delmar Learning. Stemple, J.C., Glaze, L.E., & Klaben, B.G. (2000). Clinical Voice Pathology: Theory and Management, 3rd Ed. Clifton Park, NY: Delmar Cengage Learning. Vaidya, S. & Vyas, G. (2006). Puberphonia: A Novel Approach to Treatment. Indian Journal of Otolaryngology and Head and Neck Surgery, 58..
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