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Casopis Cijeli Numerisani Jun 2021.Indd BIOMEDICINSKA ISTRAŽIVANJA UDK: 612.784-053.6 Bi 2021;12(1):90–98 DOI: 10.5937/BII2101090V Review Puberphonia: from classic to modern approach Bojana Vuković, Sladjana Ćalasan University of East Sarajevo, Abstract Faculty of Medicine Foca, The Republic of Srpska, Voice is a significant component of communication that allows us to Bosnia and Herzegovina express information and emotions, so it is the foundation of verbal communication. Maturation of the body involves dilation of the lar- ynx and lower positioning of the larynx in the neck, resulting multi- Primljen – Received: 21/01/2021 ple changes in voice quality. The rapid changes in the human larynx Prihvaćen – Accepted: 26/03/2021 during puberty are more evident in males. Such changes can result in voice mutation – puberphonia. Puberphonia, also called mutational dysphonia or mutational falsetto, is the failure of a natural decrease in Corresponding author: fundamental frequency or pitch. We can also defined puberphonia as Bojana Vuković, MA persistent adolescent voice even after puberty in the absence of or- Nemanjina 1, 73300 Foca ganic cause. This functional voice disorder can have multiple conse- [email protected] quences on the personality and quality of life of an individual that of- ten encounters problems that include psychological, emotional, social, and professional difficulties. This article aims to review the relevant Copyright: ©2021 Bojana Vuković & and accessible literature on puberphonia in a comprehensive concise Sladjana Ćalasan. This is an Open Access manner, highlighting the etiology, prevalence, clinical manifestation, article distributed under the terms of consequences on quality of life, as well as evolution of the approach the Creative Commons Attribution 4.0 and attitude to its treatment. International (CC BY 4.0) license. Key words: voice mutation, puberty, puberphonia Introduction During ontogenetic development, a human goes through two very distinct biological phases of his development, which visibly affect his physical and mental state. In the first phase is the biological ascent, puberty, or the age of significant changes in the child’s body and a major turning point in boys and girls, and the second is the biological decline, or menopause. Both phases significantly affect an individual’s voice. Numerous literature in the field of speech therapy, acoustics, phonetics, phoniatrics, psychology, psychiatry, vocal pedagogy, as well as individuals’ own experiences testify to the importance of voice and speech in human com- munication [1]. Voice is a multidimensional whole that allows us to express information and emotions, so it is the foundation of verbal communication [2]. It is a product of the synergy of several systems: respiratory, phonatory, resonant and articulatory systems. We are often not sufficiently aware of the importance of the voice and the information it gives us. By listening 1 Godištewww.biomedicinskaistrazivanja.mef.ues.rs.ba 12 Jun 2021 www.biomedicinskaistrazivanja.mef.ues.rs.ba 1 Biomedicinska istraživanja 2021;12(1):90–98 to someone’s voice, we can get information falsetto, incomplete mutation, and mutational about the speaker’s physical characteristics falsetto [6]. and also more subtle information, such as The etiology of this voice disorder has temperament, intention, emotion, or mood not been fully elucidated. However, it is con- [3]. As we mentioned earlier, the period of sidered that the main cause is the influence puberty is a period of intense changes in an of testosterone and growth hormone with individual’s voice. Puberty occurs and lasts incompatible growth of the larynx, especial- very individually. In some it occurs earlier, in ly the vocal cords. A recent study shows that some later, and that depends on several fac- there are aberrant hormonal changes in peo- tors, such as environment, diet and genetics. ple with puberphonia, expressed through In our area, the maturation of girls occurs be- higher values of GPER-1, 17β-HSD, as well tween the ages of 12 and 15, and in boys be- as cAMP compared to the control group [7]. tween the ages of 13 and 16. The duration of During puberty, developmental mutations puberty, and therefore the mutation of voice, are observed in both males and females. cannot be precisely determined. Voice muta- However, this change is more obvious in tion or so-called puberphonia is a change in boys compared to girls. During this period, the vocal apparatus due to the growth of the the larynx descends, and its dimensions in larynx and its muscles, and the enlargement the sagittal and transverse planes increase. of the vocal cords. It is a transitional period In men, the angle of the thyroid cartilage de- of changing the voice of a child into the voice creases to 90°, the length of the vocal cords of an adult. If not properly treated or given increases, and the dimension of the epiglot- importance, this functional voice disorder can tis decreases. Changes that occur during pu- have multiple consequences on the personal- berty in all organs responsible for phonation ity and quality of life of an individual, so we include an increase in respiratory capacity, believe that it is important to review relevant because the length and extent of the breast and available literature, make a review of also increase [8]. The neck increases in length knowledge about this voice disorder, which and width, which leads to a relative lowering will be useful to both, clinicians and scientists. of the larynx and a consequent expansion of the vocal tract, which increases the resonatory system. The growth of the paranasal sinuses Definition, etiology and prevalence also changes the quality of the voice. The vi- of puberphonia brational source, the vocal cords, is therefore only one of several parts of the vocal appara- Mutation of the voice during puberphonia is tus that change size during puberty, but the a functional disorder which is manifested as fundamental frequency of the voice is directly the voice with the children’s characteristics related to the vibration of the vocal cords [9]. after puberty. The appearance of voice in a In addition to these causes, the etiological fac- higher level or in the voice register is the main tors include emotional stress, delayed devel- symptom that lasts even after puberty. The opment of secondary sexual characteristics, voice of patients is continuous and weak for a psychogenic causes and excessive maternal long time, thin, breathable, hoarse, feminized protection [10]. and immature. Other symptoms are pitch Voice frequency in men falls by approxi- interruptions, inadequate resonance, and mately one octave. The voice remains in high shallow breathing [4,5]. Other terms used to intonation, but occasionally it breaks and there describe this condition include puberphonia, is a mixing of the chest register and the head adolescent transitional dysphonia, persistent register. The vocal register is a psychoacoustic 2 www.biomedicinskaistrazivanja.mef.ues.rs.ba Godište 12 Jun 2021 Puberphonia term and the term “register” was used to per- However, research done in India finds that ceptually describe different registers of voice the prevalence is 1 per 900,000 inhabitants quality contained in certain tone ranges. The [16]. Also, some studies find that of all voice three main modes of phonation are classified disorders 2−3% are mutational falsetto, or as laryngeal modes or registers. These are puberphonia [17]. Other studies that address chest, middle and head registers. These three this problem always refer to this frequency registers usually correspond to frequency data, as no more comprehensive study has ranges: low, medium, and high [11]. The typ- been done to examine the prevalence of this ical fundamental frequency of an adult male voice disorder. is between 85−180 Hz, and of an adult female around 165−255 Hz [12]. The characteristic of puberphonia is that a boy continues to use Puberphonia and quality of life higher tonality that strains the laryngeal mus- cles. Therefore, the voices of girls and boys The human voice is an individual product that show similarities before puberty, after this of the interaction of a complex physiolog- period differ significantly in gender and voice ical function that reveals uniqueness, be- quality in terms of specific, low frequencies in cause individuals can be recognized by voice men [8,13]. There are three phases in the mu- [18,19]. The personal characteristics of the tation period (9−16 years). In the permutation voice heard by the person-listener can shape phase, the first symptoms of mutational voice the flow of communication [20]. When vocal change appear at the age of 9 to 10 years. The characteristics deviate from gender, age and main mutational phase is characterized by a culturology in the background of the expect- rough, hoarse voice quality and a successive ed norm, the sound of the voice can attract decrease in pitch over a relatively short period more attention than the messages themselves. of time; it can take several months. The post- Therefore, it is not surprising that individ- mutation phase is the last phase and involves uals with a voice disorder can be identified the stabilization of the male voice; it is charac- by their voice disorder instead of the whole terized by lowering the volume range and sta- personality [21,22]. In the same way, the det- bilizing the pitch. Most adolescents complete rimental consequences of voice impairment the mutation phase at the age of 17. include the risk of losing social role [23]. Typ- Although mutational falsetto is a tempo- ical psychologically accompanying problems rary voice, in cases when it is not treated, it of chronic illness in general, as well as in per- can turn into a chronic voice disorder [14]. sistent voice disorders, include depression, Especially, if resonance is interrupted during anxiety, and tension [24]. Voice production vocal performance and if voice control is re- is a critical component of social interactions.
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