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Relaxation Thyroplasty - A Classical Surgical Approach for Puberphonia

Arjunan Karthikeyan,Balasubramanian Thiagarajan

The persistence of adolescent voice even after puberty in the absence of organic cause is known as puberphonia. 1,2,3 The condition is commonly seen in males.1-7 . This case report illustrates a novel surgical method “Retrusion thyroplasty” in the management of puberphonia. Introduction: The persistence of adolescent voice even after puberty in the absence of organic cause is known as puberphonia. 1,2,3 The condition is commonly seen in males.1-7 Normally adolescent males undergo voice changes due to sudden increase in length of vocal cords due to enlargement of thyroid prominence (Adam’s apple). This is uncommon in females because their vocal cords do not show sudden increase in length. This sudden increase in length of vocal cords is due to sudden increase in testosterone levels found in pubescent males. 1,4 Children reach puberty around 12 years of age when their hormone levels begin to become elevated. In males, this is also the age when their larynx has a rapid increase in size. The vocal cords become longer and begin to vibrate at a lower pitch (or frequency). This explains why most males go through the period of voice breaks. The vocal cords are trying to adjust to their new dimensions. No such laryngeal changes take place in females who continue using a high pitched voice. According to Banerjee the incidence of puberphonia in india is about 1 in 9,00,000 population.2,5,6 Even though the incidence is low, for a individual it causes social and psychological embarrassment. In infants laryngotracheal complex lies at a higher level. It gradually descends. During puberty in males the descent is rapid, the larynx becoming larger and unstable and on top of it the brain is more accustomed to infant voice. The boy may hence continue using high pitched voice even after puberty or it may break into higher and lower pitches.1,5