{"title":"Voice Therapy for Puberphonia in the Adolescent Male: A Clinical Case Study.","authors":"Lydia R Kruse, Robert Brinton Fujiki","doi":"10.1044/2025_persp-25-00222","DOIUrl":null,"url":null,"abstract":"<p><strong>Clinical scenario: </strong>Puberphonia (also known as mutational falsetto) occurs when an individual maintains prepubescent speaking fundamental frequency (<i>F</i>0) after the laryngeal changes associated with puberty have taken place. Voice therapy with a speech-language pathologist (SLP) is the primary treatment for puberphonia; however, resources describing treatment techniques specific to this patient population are lacking.</p><p><strong>Clinical question: </strong>What diagnostic and treatment procedures are employed in the course of treatment for an adolescent presenting with puberphonia? What factors influence intervention?</p><p><strong>Study sources: </strong>Henry, a 13-year-old adolescent male, was diagnosed with puberphonia with a muscle tension component. Voice quality was characterized by roughness, strain, and elevated speaking pitch for his age and gender. Voice therapy was recommended and pursued. Audio recordings, acoustics, patient-reported outcome measures, auditory-perceptual evaluations, and laryngeal imaging findings are presented in detail. Considerations for course of treatment are discussed.</p><p><strong>Primary results: </strong>Initially, Henry did not tolerate manual laryngeal reposturing. Thus, dysphonia and speaking <i>F</i>0 were targeted through semi-occluded vocal tract exercises and resonant voice techniques. After four sessions, no change in speaking <i>F</i>0 was observed; however, muscle tension was sufficiently reduced to implement manual laryngeal reposturing. Three sessions implementing this technique resulted in <i>F</i>0 reduced to normative range and resolution of dysphonia. Henry and his family initially expressed trepidation about the sudden changes in his voice quality, but gradually welcomed them as his vocal efficiency and voice-related quality of life improved.</p><p><strong>Conclusions: </strong>This case study supports past work indicating that voice therapy effectively reduces <i>F</i>0 and improves voice quality in adolescents with puberphonia. Manual laryngeal techniques were particularly useful in reducing speaking <i>F</i>0. Future clinical trials should continue to examine the efficacy and efficiency of voice therapy for adolescents with puberphonia.</p><p><strong>Supplemental material: </strong>https://doi.org/10.23641/asha.31032382.</p>","PeriodicalId":74424,"journal":{"name":"Perspectives of the ASHA special interest groups","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2026-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12920004/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Perspectives of the ASHA special interest groups","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1044/2025_persp-25-00222","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
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Abstract
Clinical scenario: Puberphonia (also known as mutational falsetto) occurs when an individual maintains prepubescent speaking fundamental frequency (F0) after the laryngeal changes associated with puberty have taken place. Voice therapy with a speech-language pathologist (SLP) is the primary treatment for puberphonia; however, resources describing treatment techniques specific to this patient population are lacking.
Clinical question: What diagnostic and treatment procedures are employed in the course of treatment for an adolescent presenting with puberphonia? What factors influence intervention?
Study sources: Henry, a 13-year-old adolescent male, was diagnosed with puberphonia with a muscle tension component. Voice quality was characterized by roughness, strain, and elevated speaking pitch for his age and gender. Voice therapy was recommended and pursued. Audio recordings, acoustics, patient-reported outcome measures, auditory-perceptual evaluations, and laryngeal imaging findings are presented in detail. Considerations for course of treatment are discussed.
Primary results: Initially, Henry did not tolerate manual laryngeal reposturing. Thus, dysphonia and speaking F0 were targeted through semi-occluded vocal tract exercises and resonant voice techniques. After four sessions, no change in speaking F0 was observed; however, muscle tension was sufficiently reduced to implement manual laryngeal reposturing. Three sessions implementing this technique resulted in F0 reduced to normative range and resolution of dysphonia. Henry and his family initially expressed trepidation about the sudden changes in his voice quality, but gradually welcomed them as his vocal efficiency and voice-related quality of life improved.
Conclusions: This case study supports past work indicating that voice therapy effectively reduces F0 and improves voice quality in adolescents with puberphonia. Manual laryngeal techniques were particularly useful in reducing speaking F0. Future clinical trials should continue to examine the efficacy and efficiency of voice therapy for adolescents with puberphonia.
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