Himani Tyagi, MASLP (AIISH,
Mysore) Audiologist, Chacha Nehru Baal Chikitsalya
Bindu, MASLP (AIISH, Mysore)
The persistence of adolescent voice even
after puberty in the absence of organic cause is known as puberphonia. The
condition is commonly seen in males. Normally adolescent males undergo voice
changes due to sudden increase in length of vocal cords due to enlargement of
thyroid prominence (Adam’s apple). This is uncommon in females because their
vocal cords do not show sudden increase in length. This sudden increase in
length of vocal cords is due to sudden increase in testosterone levels found in
pubescent males. Children reach puberty around 12 years of age when their
hormone levels begin to become elevated. In males, this is also the age when
their larynx has a rapid increase in size. The vocal cords become longer and
begin to vibrate at a lower pitch (or frequency). This explains why most males
go through the period of voice breaks. The vocal cords are trying to adjust to
their new dimensions. No such laryngeal changes take place in females who
continue using a high pitched voice. The incidence of puberphonia in India is
about 1 in 9,00,000 population. Even though the incidence is low, for an
individual it causes social and psychological embarrassment.
In infants laryngotracheal complex lies
at a higher level. It gradually descends. During puberty in males the descent
is rapid, the larynx becoming larger and unstable and on top of it the brain is
more accustomed to infant voice. The boy may hence continue using high pitched
voice even after puberty or it may break into higher and lower pitches
Case Report:
21 years old male came to ENT OPD Yashoda
Super specialty hospital with complaints
of persistence of adolescent voice since childhood. There was an inability to
raise his voice with frequent pitch breaks. And he complained of voice fatigue.
He was psychologically depressed due to social embarrassment.
On examination his Adam’s apple was
prominent. Laryngeal contour normal. Gutzmann pressure test (external downward
pressure on the thyroid cartilage will often evoke normal sounding voice) was
positive. Secondary sexual characters developed normally. Psychological
evaluation shows the patient was psychologically disturbed. Initially he was
referred to speech therapist and completed a course of voice therapy but he did
not show any improvement . He was emotionally disturbed and anxious to get
normal adult voice. So isshiki type 3 relaxation thyroplaty was planned
under local anesthesia
Procedure:
Procedure
was done under local anesthesia. Previously patient was put on nil per oral for
6 hours. A 1 and half inch incision given over proximal neck crease.
With
gentle dissection thyroid cartilage was exposed.
Two
incisions were given just 3 mm parallel to midline and anterior thyroid
cartilage was pushed posterior so that lateral thyroid cartilages override the
midline thyroid cartilage.
CONCLUSION
Even though speech therapy is the most
accepted management modality in managing these patients, in extreme cases if
the situation warrants a surgeon should extend his longest arm to rescue the
patient
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