9 holes opening and closing

Forced Expiratory Technique

Steps of active Low pitch voice creation – puberphonia treatment by closing various opening( 9 opening) in the pharynx and mouth.

Breathe in and out gently through your nose if you can. If you cannot, breathe through your mouth instead. This is a manoeuvre used to move air, mobilised by deep breathing/thoracic expansion exercises, downstream towards the mouth. A huff (blow out air loudly) is exhaling through an open mouth and throat instead of coughing. Huffing helps moves air from the small airways to the larger airways, from where they are removed by force as coughing alone cannot remove air from small airways. Puberphonia boy is requested to shout with open mouth. The voice should come from soft palate, not from the larynx. He can continue to practice with the thread inside the mouth. Regular voice therapy makes a permanent male voice. The important of voice therapy: The voice should come from the tooth, lip, tongue, nose and palate. Not from the larynx. 

Concept of this therapy

500 years back Tholkappiyar clearly told about the origin of voice and production voice and how to strengthen the voice. Voice should come from lower abdomen the sound should vibrate and resonate in the head, neck and chest. The voice should be delivered out only by tooth, lip, tongue, nose and palate. So palatal voice should be practiced before this surgical procedure. Patient is encouraged to stand in front of the mirror and practice to make loud noise with open mouth with the movement of the soft palate.

For this three types of forcible expiration is done with loud noice.1, two arms should be stretched forward and with inspiration, hand is flexed to the chest and with open mouth. Then make loud voice with palate along with forceful stretching out of arms: 2. Move the hand downward, with inspiration flex the hand to the chest and make loud noise while expiration with open mouth and movement of the soft palate, stretch out the arms forcefully downwards. 3. Similarly the hand should be raised above the head and then bring hand to the chest with inspiration. Forcefully stretch upward the hand with open mouth shouting done with palate movement.

The same things should be repeated several times. For 1 to 2 hours patient should shout with his high voice. It will become a permanent adult male voice. Out of eleven cases six cases had alternating high voice and puberphonia. With good encouragement next day itself these cases even picked up adult male voice and later they had been habituated into normal adult voice.