puberphonia

Puberphonia, also called mutational falsetto, is the persistence of a prepubertal voice after puberty. It most often affects males and is typically a functional voice disorder in which the voice remains unusually high in pitch despite appropriate physical maturation.

Individuals with puberphonia may have a high perceived pitch, limited vocal projection, creaky or breathy quality, reduced loudness, and difficulty speaking in lower registers. The condition can be accompanied by social or communication concerns, but there is usually no pain or structural abnormality in the larynx.

Etiology is multifactorial and may involve learned voice habits, functional laryngeal tension, and psychological or social factors. In many cases, there is no underlying organic disease; laryngoscopic examination shows normal vocal fold structure and function, with elevated fundamental frequency.

Diagnosis relies on history, voice assessment, and endoscopic evaluation to exclude organic causes such as vocal fold lesions, inflammation, or neurological disorders. Acoustic analysis often shows an abnormally high fundamental frequency for age and sex.

Management is primarily voice therapy with a speech-language pathologist, focusing on producing a modal voice, improving laryngeal tension, and training in resonance and breath support. Techniques may include pitch exercises, glottal adduction methods, and relaxed throat posture. In rare cases, addressing psychological factors can improve outcomes. Surgery is not a standard treatment for puberphonia.

Prognosis is generally favorable, with most individuals benefiting from timely voice therapy. Some cases resolve spontaneously during late adolescence or after increased vocal training.