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A Male With Female Voice

Readers, please do not get a wrong idea with the above topic. It does sound weird, but it’s not impossible. It can happen when a full grown men who had undergone physical changes during puberty, but their high pitch voice remains unchanged. For those affected, they actually have a voice problem known as puberphonia.

Who has puberphonia?

Puberphonia is a condition that usually affects men. There are some women who have a high pitch voice like their childhood voice after puberty, but the society never has a problem with that. But when it comes to men, it is not considered as normal. Of course it will be weird to hear a high pitch speaking voice coming from a full grown man, right?

Video 1 : Shows a person who has puberphonia

Characteristics of puberphonia:

  • Has a high pitch voice that is not suitable to one’s gender and physical characteristics.
  • Objectively, puberphonia can be confirmed when the fundamental frequency of a speaker is higher than the normal range, i.e. 120Hz for a male speaker and 210Hz for a female speaker.
  • Have difficulty to produce loud voice and easily feels tired when speaking for a longer period of time.
  • Misidentified as a woman when speaking through the phone
  • Other symptoms:
    • Hoarse voice
    • Pitch break
    • Inadequate resonance
    • Muscle tension
    • Lack of voice variability

How puberphonia happened ?

To understand how puberphonia happened, we must first understand how the voice is produced.

The voice is a result of the vocal cord vibration. The structure of the vocal cords, i.e. its length and thickness affects the frequency of the voice. The thicker and longer the vocal cord, the lower the frequency will be. A voice with high value of the fundamental frequency is perceived as a high pitch voice, and a voice with low value of the fundamental frequency is perceived as a low pitch voice.

Normal changes of vocal cord

  • In children, the length of the vocal cord in both genders is around 2 millimetres.
  • Because of the tiny structure of the vocal cord, children’s voice has a higher value of fundamental frequency, i.e. 300 Hz, and perceived as a high pitched voice.
  • The characteristics of a child’s voice will change together with their physical chances throughout puberty.
  • Female vocal cord will grow about 0.4mm in a year, and the male vocal cord will grow 0.7mm for the same period of time.

Difference between a male and a female vocal cord

  • The difference in the structure of the vocal cord in male and female contributes to the difference in the quality of the voice between them.
  • Female voice has a fundamental frequency around 210 Hz, while men have a fundamental frequency around 120Hz.
  • Difference in the value of the fundamental frequency gives the perception of a female or male voice.
  • A male voice has a lower fundamental frequency when compared to a female voice.
  • The following table showed the differences of the vocal cords between genders:
Features of voice and vocal cords Male Female
Structures Long and thick Short and thin
Frequency 120 Hz 210 Hz
Perception of voice Sounding big and rough Sounding soft and pleasant

Differences in voice changes in a person with puberphonia

In person with puberphonia, the vocal cords have undergone physical changes, but their voice remains unchanged. The value of the fundamental frequency remains higher than normal value despite the change that occurs to their vocal cord structures.

Why puberphonia happens?

There are many theories discussed in relation of the factors that may cause puberphonia. Among those are physical factors and psychological factors.

1. Physical factors
  • Medical problem such as hearing problem and vocal cord paralysis
  • Structural problem such as vocal cords nodule or polyp
2. Psychological factors
  • The voice changes that occur in relation to puberty may cause embarrassment and anxiety. A person with puberphonia will then subconsciously maintains the high pitch voice even though their vocal cord structures had undergone normal changes

Diagnosis

Initial assessment

  • Initial examination includes examination from a medical officer or a specialist to rule out any structural abnormality of the patient’s vocal cord
  • Vocal cord assessment can be done via several approaches, including the use of trans-nasal endoscopy.
  • A person with puberphonia will then refer to Speech Language Pathologist for further assessment.

Video 2 demonstrate the use of trans-nasal endoscopy equipment to examine the structure and function of the patient’s vocal cords.

Further assessment

  • Speech Language Pathologist
    • Speech Language Pathologist (SLP) is a professional who is trained and involved in the management of a person who has language, speech, voice, resonance or swallowing problem.
    • In general or private hospital setting, SLP is usually referred to as a Speech Therapist and is usually a part of Ear, Nose and Throat (ENT) or rehabilitation department.
  • Clinical assessment
    • The SLP will usually use clinical instruments, with specific reason to assess a person who has puberphonia. The reason of the assessment may include, but not limited to:
      • Assess the patient’s fundamental frequency with a special instrument or assess the pitch with perceptual assessment
      • Performed a detailed assessment regarding the patient’s daily vocal use, and their own perception of their voice quality.
      • Determine any related factors that may cause the problem, or factors that may affect prognosis or outcome of therapy.

        Picture is showing use of instrument for voice assessment
        Source: Truman State University website

Effects of puberphonia

Puberphonia may cause secondary voice problem or psychosocial problem.

  • Secondary voice problem
    • Secondary voice problem can occur due to vocal cord misuse, causing muscle tension and fatigue. This will cause secondary voice problem such as voice hoarseness and voice weakness.
  • Psychosocial problem
    • Voice quality gives significant effect to a person’s overall personality or image. Full grown men that sound like women will definitely attract one’s attention. For some person, Puberphonia may cause low self esteem or anxiety, but this of course depends on a person’s personality.

Treatment

Puberphonia can be treated with 2 approach, i.e. non-medical approach or medical approach. A patient will be referred to other professional if he/she shows any involvement of physical factors, such as hearing difficulty.

  • Non medical approach

    Non medical approach will be performed by the SLP, using many types of technique in a therapy program known as voice therapy. This type of treatment may be the only treatment needed to treat puberphonia, especially when there is no involvement of any physical factors.

    Voice therapy:

      • Using voice therapy program, the SLP will help a patient to:
        • Understand the function of the vocal cord
        • Evaluate the pitch quality of their own voice
        • Determine the pitch that they want to achieve after the therapy
      • Voice therapy may include the use of any biofeedback instruments to help the patient to visually monitor changes in the voice pitch/ frequency accurately.
      • No matter what technique that is used by the SLP, the ultimate goal of voice therapy is to lower the frequency of the patient’s voice.

        Video 3 shows the changes in the patient voice (patient in  video 1) after he had voice therapy 

  • Medical approach

    Medical treatment for puberphonia must be performed by a well trained medical officer or specialist. Two types of medical treatment available to treat puberphonia are Botox injection and surgical intervention.

    Botox injection :

    • This type of treatment involves injection of Botox to the specific muscle, with specific dosage and frequency to help relaxation of the muscle.

      Botox injection to the vocal cord
      Source: Yeson Voice Centre

    Surgical intervention :

    • This type of intervention will only be carried out after all other approach is unsuccessful. The surgical procedure is known as Isshiki Type III relaxation thyroplasty, is a laryngeal framework surgical procedure that is performed aimed to lower a patient’s voice frequency.

References

  1. Moynahan, M (2003). Puberphonia. [Power Point slides]. Retrieved September 3, 2012 from https://www.msu.edu/course/asc/823c/…/Puberphonia.ppt
  2. Puberphonia. (n.d).  In the La Trobe University webpage. Retrieved September 3, 2012 from http://www.latrobe.edu.au/communication-clinic/voice/disorders/puberphonia.html
  3. Surgical management of puberphonia: Recent concept.   (n.d.) In the drtbalu’s Otolaryngology online. Retrieved September 4, 2012 from http://www.drtbalu.co.in/puber_rec.html
  4. Traunmüller, H dan Anders Eriksson,A. (1995). The frequency range of the voice fundamental in the speech of male and female adults  [PDF  Document] Retrieved from www2.ling.su.se/staff/hartmut/f0_m%26f.pdf
  5. Pincus. R.L (n.d) In the New York Otolaryngology group. Retrieved September 15, 2012 from http://www.nyogmd.com/2011/06/im-a-19-year-old-man-with-a-high-pitched-voice-is-there-anything-i-can-do/
Last Reviewed : 9 March 2016
Writer / Translator : Rahimah bt. Yunus
Accreditor : Nur Fariha bt. Md. Shah