My Diagnosis: A Psychogenic Voice Disorder – Puberphonia
By Steven J Dennis
First and foremost, I would like to thank everyone who has read my piece, it means so much to me! When deciding to write and publish this piece I never envisioned this response. I was apprehensive before sharing it, but since then it has been read internationally, and the overall response is positive and overwhelming; It is more than I ever anticipated. I have now decided to continue documenting and publishing content and turn – Pitch Imperfect into a series.
So far, I have shared the history of the issues and problems I have faced with my voice. But from this point, I will be sharing and documenting the process I now face. A new era into this journey is beginning and for the first time, I am excited to see where this will lead.
February 18th
To continue from my last piece, I had an appointment with an ENT (ear, nose and throat) specialist at the Royal National Throat, Nose and Ear Hospital in London, on February 18th, 2019.
I was very nervous about this appointment but equally excited. It felt like I was going to finally have the answers I have been seeking all these years. I was expecting to have extensive tests and examinations, as the appointment letter stated that I would be at the hospital for 2-3 hours. However, the appointment was shorter than expected; I must have been there for less than an hour. It began by going over the medical notes from previous doctors and going over the concerns I have with my voice. After this discussion, the specialist took me over to perform a laryngoscopy and shortly after, it was all over.
This procedure involves a scope; a thin flexible tube that is inserted through the nose and guided to the throat to directly inspect the nose, throat, and larynx for abnormalities. It is not painful, but it is uncomfortable as it is guided through the nasal cavity and into the throat. Once the camera had a clear image of my larynx, the specialist asked me to make different sounds and cough to see how my larynx moves. Fortunately, no alarming irregularities were detected, but the specialist could identify what is causing my voice to be high-pitched.
The Diagnosis
After the
laryngoscopy, the specialist informed me of the condition that is causing my
voice to be high-pitched, and it is called puberphonia. I was overcome with
relief as he was talking about the condition; it was like it was rushing
through my body as he was talking. It felt like a huge leap forward. The
unknown and wonder with what is causing my voice to be high-pitched immediately
disappeared. I finally knew the name. I finally had the answer.
Puberphonia
There are limited resources available online on the condition. So, I am informing you all with notes from the specialist and mainly what I can find on old faithful – Wikipedia.
Puberphonia is a psychogenic voice disorder. Defined as the persistence of a high-pitched voice during puberty and continues into adulthood if not treated. The condition becomes permanent as there is strong tension surrounding the larynx as well as no muscle control/memory, and poor breath control. Also, characterised by a higher pitch that would be inappropriate for the age and gender of the patient.
Puberphonia in general population is 1 in 900,000 (Bannerjee et al., 1995).
During puberty, anatomical changes in the larynx typically result in a decrease in pitch in both males and females. However, the larynx descends and grows significantly larger in males which often results in a visible laryngeal prominence on the neck – commonly known as an Adam’s Apple. Additionally, male vocal folds become longer and thicker, and these changes contribute to the deepening of the voice in pubescent males. Puberphonia is the failure to transition into the lower pitched voice during puberty. In conjunction with an atypically high-pitch, common symptoms include a weak, breathy, or hoarse voice, as well as low vocal intensity, pitch breaks, and shallow breathing.
The specialist explained that in the laryngoscopy he could see that I am capable of producing a lower pitch. My vocal folds had developed during puberty, but the habitual use of a higher pitch has caused tension in the muscles surrounding the vocal folds – resulting in a higher pitch. But my larynx is incapable of supporting a lower pitch as the tension in the muscles is restricting, and the muscles are too weak to resist and maintain a lower pitch. This condition explains why I have a prominent Adam’s Apple but a high-pitched voice. Also, why I can’t annunciate and project my voice.
Puberty Paradox
The direct cause of puberphonia is unknown but it is heavily linked to psychological disorders and can be influenced by:
- Emotional stress
- Delayed development of secondary sex characteristics
- Resistance to pubertal changes
- Self-consciousness resulting from an early breaking of the voice
- Self-consciousness resulting from emerging adulthood
- Excessive admiration of another male or sibling
If you have read my previous piece, you’ll see that I can probably tick a few boxes. It’s ironic that the thing I yearned for most during puberty is also the thing I didn’t allow myself to have. And now it is stuck. However, I was unaware of the damage I was inflicting to myself. Puberphonia is not a disorder that is likely to go away on its own, and without treatment, the higher pitch will be permanent.
My Treatment
Previously, I have had speech therapy, but it was unsuccessful. The specialist read through the notes from the speech therapist and said I had been receiving the wrong treatment. Rather than techniques to relieve the tension in my larynx, the methods they were teaching me were to control and improve my breathing. As well as articulation techniques such as vocal warm-ups and lip movement; to improve my vocal articulation. However, as the tension still surrounds my vocal folds, I was experiencing little change in the pitch. When I would attempt a deeper voice, it would sound unnatural. Due to the muscles in the larynx retracting as it is unable to maintain the deeper registry and the pitch would break, and sound forced and breathy.
As much as I had hoped for surgery, the specialist elaborated that the surgical procedure may not give the voice I desire. Although it is a quicker way to relieve the tension, it is invasive, and the recovery process may still require speech therapy.
The outcome of the specialist appointment is to undergo speech therapy again. However, it will be different; this therapy will be intense, and the therapists specialise in puberphonia cases. There is a three-month waiting period, but I’m hoping that speech therapy this time will have a greater impact and I’ll achieve a deeper voice. I assume that if the specialised speech therapy remains unsuccessful, I will then undergo the surgical procedures to resolve the tension in my larynx.
If you would like to read more on the conditions, here are the sites I found useful:
http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=954&Type=FREE&TYP=TOP&IN=&IID=83&isPDF=YES
http://www.jorl.net/otolaryngology/puberphonia-conservative-approach-a-review.pdf
https://en.wikipedia.org/wiki/Puberphonia
[GRAPHIC CONTENT] http://www.jorl.net/otolaryngology/relaxation-thyroplasty–a-classical-surgical-approach-for-puberphonia.pdf
IVLUTION 