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management of puberphonia recent concepts
This condition is caused due psychological problems in the patient which prevents lowering of the pitch of the voice of an adolesecent to that of a adult range. Puberphonia is more common in adolescent males and may also occur rarely in females.
The following are the probable psychological factors that could lead to the developement of puberphonia:
The pitch of the voice in puberphonia is caused by increased tension of laryngeal musculature. This condition is responsive to voice therapy. If voice therapy fails then botulinum toxin injection into the cricothyroid muscle could be of help. Ideally 15 units of Botulinum toxin can be injected to each side.
Surgical management of Puberphonia:
When all the
above conservative methods fail then surgery will have to be resorted
to. Isshiki type III relaxation thyroplasty has shown promise in
managing these patients. This surgical procedure lowered the pitch
of voice in these patients by shortening the length of the vocal
folds. In the classic Isshiki type III thyroplasty 2 – 3 mm of
vertical strips of cartilage were excised on each side of midline of
thyroid cartilage. This procedure caused retrusion of the middle
portion of the thyroid cartilage causing a reduction in the length of
the vocal folds.
Various modifications of Type III Ishikki thyroplasty have been proposed. These include:
In this modified procedure the lamina of thyroid cartilage is incised bilaterally and its anterior segment is depressed anteriorly.
In this procedure a small window is created close to the anterior commissure tendon and the cartilage window created is pushed behind.
This is a less invasive procedure in which a superiorly based cartilage window is created at the level of anterior commissure and is pushed behind causing relaxation of the vocal folds.
This surgical procedure is very useful in treating
patients in whom psychologic counselling and voice therapy has
showing the depressed anterior segment of the thyroid cartilage
Figure showing the anterior segment of thyroid cartilage which has been pushed behind and the free edges of thyroid cartilage reapproximated