Redirecting phonation from the larynx to other vibrating structures in the vocal tract to treat puberphonia and a new assessment
Dr.M.Kumaresan and Dr.K.Navin Bharath, 9841055774, kumaresan@doctor.com
Accepted finding
No. 1. The longest established method of indirectly viewing the interior of the larynx is mirror laryngoscopy. In this procedure, the otolaryngologist places a laryngeal mirror against the patient’s elevated soft palate as he or she says ‘ee’ at a relatively high pitch only. Vocal cords produce only high-pitched voices. To make a low-pitched voice, we have to redirect phonation. Although this technique enables the larynx to be viewed at rest and during phonation, it does not permit an assessment of the larynx during connected speech (the presence of the laryngeal mirror in the oral cavity prevents speech). To get a low pitch, it is better to redirect phonation from the larynx.
No. 2: Puberphonia patients need a detailed ENT evaluation. A stroboscope was used to obtain a visual assessment of the vocal cords. A perceptual assessment of the patient's voice was done using the GRBAS scale. The Voice Handicap Index (VHI) was developed and validated by Jacobson et al. for various dimensions of a voice disorder to be quantified. Typically, this is achieved by means of scales. One of the most widely used scales in the UK and internationally is the GRBAS scale of the Japan Society of Logopaedics and Phoniatrics, which was given its introduction in Hirano (1981). This perceptual rating system contains five parameters: G (overall grade of hoarseness), R (roughness), B (breathiness), A (asthenic), and S (strained quality). The GRBAS scale is not fully comprehensive; it does not include parameters for vocal pitch, for example (Freeman and Fawcus 2000). Nevertheless, this scale is a reliable method of perceptual assessment that has also been shown to correlate with voice-related quality of life (Karnell et al. 2007; Jones et al. 2006).
This scale consists of judging voice quality on the basis of grade (G), roughness (R), breathiness (B), asthenia (A), and strain (S) in voice production. Assess the patient and hear their voice. On hearing the voice, the diagnosis is confirmed. Measure the patient’s frequency of speech with an Android cell phone. By demonstrating different speech frequencies, you can gain the patient's trust.
Our method of perceptual assessment: The types of continued occurrence of voice in puberphonia:
Assessment before treatment
Ladies Voice: A sexy voice is warm and inviting. It feels as if it is spoken from the chest rather than the head. Its tones are pleasing and not at all nasal.
Child voice: when they talk about their feelings or express them in an appropriate way.
High Pitch: Women with relatively high-pitched voices are typically perceived as more feminine, younger, and more attractive.
Hoarseness is a condition marked by changes in the pitch or quality of the voice, which may sound scratchy or husky.
Breathy voice: A breathy, airy singing voice means too much air, with the sound of voice escaping through the mouth. This causes a soft, breathy tone that's hard to hear.
Vocal fatigue, loss of intonation or expression,
Double Voice: The chest voice is your lower range, while the head voice is your higher range. The reason why people often feel like they have these two different voices that don't connect is because they have not developed their mix (of their middle register or middle voice). The mix is the bridge between the low and high vocal ranges.
The nasal voice is inappropriate because it increases airflow through the nose during speech.
Indifferent voice, having no preference, or being uninterested, since one doesn't want to indicate having any strong feelings
Inaudible Sound: The simplest noise reduction works primarily by lowering efforts to talk.
Our voice index before treatment: assessing the patient's statement
All have 10 qualities of voice, mostly mixed.
1.Child voice: 40%
2.Female voice: 39%
3.Double voice: 10%
4.High-pitched voice: 1%
5.Breathy voice: 1%
6.Nasal voice: 61%
7.Vocal fatigue: 51%
8.Hoarseness: 1%
9.Indifferen: 70%
10.In audible: 81%
Assess resonance quality, such as normal, hypo nasal, hyper nasal, or cul-de-sac.
1. If abnormal, assess stimulability for normal resonance. 2. If normal, evaluate the focus of resonance, such as (a).oral, (b) pharyngeal, (c) laryngeal, or (d)nasal.
This is very important because puberphonia boys will never try to resonate; it is a learned behavior. Most of them have less activity in the vocal tract.
Measurements of nasalance (vowel /a/, /i/, consonant /m/, oronasal, oral, and nasal texts), nasality degree (Gutzmann test and Bzoch hyper nasality test), voice (acoustic analysis), and articulation (velar sound) were taken before and 3 months after the procedure and compared.
Our voice index: assessment based on observation while a puberphonia boy talks
Laryngeal: overstrain in the neck, 0%
- less strain in the neck 88%
Nasal 89%
Oral 11%
Pharyngeal 0%
