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Puberphonia (also known as mutational falsetto or mutational chink) is the persistence of adolescent voice even after puberty.[1]


The laryngeal prominence, commonly known as the Adam's Apple.

Normally adolescent males undergo voice changes due to a sudden increase in the size and thickness of the Vocal folds due to the enlargement of the Adam's Apple. This is uncommon in females because their vocal folds do not show a sudden increase in size. This sudden increase in the size of the vocal folds is due to the sudden increase in testosterone levels found in pubescent males.[2]


The persistence of adolescent voice even after puberty in the absence of organic cause is known as Puberphonia. This condition is commonly seen in males. The patient has an unusually high pitched voice persisting beyond puberty. This is uncommon in females because laryngeal growth spurt occurs commonly only in males.


  • Emotional stress
  • Delayed development of secondary sexual characteristics
  • Psychogenic
  • Skipped fusion of thyroid laminae


Voice therapy

This condition is best treated by voice therapy (vocal exercises) by speech-language pathologists (SLPs) /speech therapists having experiences in treating voice disorders because puberphonia is not a very common problem. The duration of treatment can usually be one to two weeks.[3]

It includes:[4]

  • Cough
  • Speech range masking
  • Glottal attack before a vowel
  • Relaxation techniques to relax the laryngeal musculature
  • Visi pitch
  • Lowering of larynx to appropriate position
  • Humming while sliding down the scale
  • Half swallow Boom technique
Larynx manipulation

Type III phonosurgery can be done, which includes surgical shortening and relaxation of the vocal cords.[5]


The incidence of puberphonia in India is estimated to be about 1 in 900,000 population.[6]


  1. ^ Vaidya, S; Vyas, G (Jan 2006). "a" (PDF). Indian J Otolaryngol Head Neck Surg. 58 (1): 20–21. doi:10.1007/BF02907732. PMC 3450609. 
  2. ^ Aronson, Arnold Elvin; Bless, Diane M. (2009). Clinical Voice Disorders. 
  3. ^ Boone, Daniel R.; MacFarlane, Stephen C.; Von Berg, Shelley L.; Zraick, Richard I. (2010). The voice and voice therapy. Allyn & Bacon. 
  4. ^
  5. ^ Puberophonia-surgical management with modified ishiki thyroplasty type III Der Pharmacia Lettre, 2014, 6 (2):77-81
  6. ^ Banerjee AB, Eajlen D, Meohurst R, Murthy GE (1995) Puberphonia – a treatable entity. world voice congress oporto portugal

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