Friday, 4 June 2021

Chapter 21 New anatomical and physiological perspectives of Eustachian tube


Chapter 21

New anatomical and physiological perspectives of Eustachian tube

Nasopharynx is considered as the dark area of otorhinolaryngology practice,

New anatomical perspectives: Eustachian tube/ sac, a resonating chamber for vocalization

More recently, two developments has enhanced our undertanding of the anatomy of the eustachian tube: Valsalva computerized tomography and endoscopic ear surgery.

1.    Given the greater access to the ear anatomy using endoscopic methods, it has been suggested that the bony part of the eustachian tube is really the anterior extension of the middle ear cavity, or the "Protympanum". The term "Eustachian Tube" should be limited to the fibrocartilaginous structure connecting the protympanum to the nasopharynx.[4]

2.    The Eustachian tube is a sac like irregular structure rather that a tubular structure.

3.     Possible functions of the guttural pouches include pressure equilibration across the tympanic membrane, contribution to air warming, a resonating chamber for vocalization, and a flotation device.

4.     Eustachian tube in vocalization.

5.     Eustachian opening is one another door for the body. The other nine doors are, two eyes, two ears, two nostrils, mouth, anus and genital. Anus and genital are not door, but a orifice with one way traffic. How can it be a door?

Yarning and snoring produce low pitch voice. Yawning produce low pitch sound. Yawning also helps open the Eustachian tube or opened Eustachian tube resonate the sound. ,Yawning, which is by far the most popular approach to teaching an open throat, tends to produce an overly open pharyngeal space, and thus a hollow, 'throaty' tone.  We fond of some of the methods of creating an open throat space, particularly those involving imagery or shaping of the vocal tract that encourages the distortion of vowels. For instance It also tends to be accompanied by a flattening or retracting of the tongue. Whenever a teacher instructs a student to yawn in order to 'open the throat', he or she overlooks the injurious ramifications of such a technique when it is applied to the tasks of puberphonia speech training.


Yarning                                                                     Snoring

If the puberphonia speech training boys reaches the point where he or she really feels a hugely open space in the throat - the feeling that he or she is 'swallowing an egg' or some other piece of fruit, for example - it is actually likely that the tongue root is so out of the way of the mouth cavity that it is depressing the larynx. What is an effort to free up space for the voice to resonate better actually ends up placing tension on the throat, tightening it, and producing a hollow, throaty timbre.

Raising the eyebrowsfurrowing the browcreasing the foreheadflaring the nostrils or widening the eyes are linked to the lifting of the soft palate to enhanced resonance balancing.

We taught them to 'inhale' a soft, quiet 'k' sound. (This is kind of like the imagery of 'drinking in the breath' or 'inhaling the breath'.) This technique lifts the soft palate further, separating it from the tongue, and lowers the larynx during inhalation. It is one helpful technique for ensuring that the resonating spaces are open. The soft palate's motion during breathing is responsible for the sound of snoring. Touching the soft palate evokes a strong gag reflex in most people. The soft palate retracts and elevates during speech to separate the oral cavity (mouth) from the nasal cavity in order to produce oral speech sounds. If this separation is incomplete, air escapes through the nose, causing the speech to be perceived as hyper nasally. In the case of nasal consonants and vowels, it lowers to allow the velopharyngeal port to open. Velopharyngeal closure (VPC) is an important part of speech. All phonemes in the English language, with the exception of the three nasal phonemes (/m/, /n/, /ng/), are produced with oral airflow, meaning that the velopharynx should be closed. The nasal phonemes are produced with nasal resonance, meaning that the velopharynx must open during their production. a possible role for the velum in influencing Eustachian tube functioning because the tensor muscles of the velum pull the membranous lateral wall of the Eustachian tube away from the stationary cartilaginous medial wall, thereby opening the normally closed tube.

In the equids (horses) and some rodent-like species such as the desert hyrax, an evagination of the Eustachian tube is known as the guttural pouch. The guttural pouches are paired out  pocketing of the upper airway (pharynx). Among the amphibians, the frogs and toads are capable of producing the most distinctive and greatest variety of calls. Even though the female frogs and toads are able to call, they do so infrequently. The males do most of the calling, and the majority of the singing is done at the breeding sites, because the main purpose of the call is to attract a mate. However, a different call may be used to stake out a territory, the frog or toad announcing his presence and in effect warning others away. The call is produced in much the same manner as other animals produce sound—vocal chords vibrate as air passes over them. Unique to the frogs and toads, however, is the inflatable vocal sac possessed by most of them There can be one or two vocal sacs, depending on species. 

Guttural pouch are sacs of air that expand from the eustachian tube. Frog produces a low guttural, reverberant sound.

Figure III-9bThe sac is an effective resonator, like a sounding board on a stringed instrument. The sac itself, however, is not able to amplify the level of the call. As the air is expelled over the vocal chords and the call is completed, the sac deflates. It often is seen as an area of wrinkles or folded skin on the throat or shoulders of some species.Figure III-10The calls produced by the various toads and frogs range from simple clicks to whistle- or bell-like sounds to a full, resonating deep croak.


Whether the vibration happens while the source is moving, or not, does not depend at what speed the sound is going to travel through air. However, the pitch of sound will change depending upon which direction you listen in. Speed of sound is not a constant in context of relativity. Example: On a rainy day go fast in the rain, you will be more drenched. Low pitch echoes longer than higher pitch, and often the lowest harmonic of an acoustic instrument is obscured by the fundamental pitch. ... Lower air speed might be responsible for the lower-pitched echo/reverberations that seem to follow the main part of the note.

Ancient Greek mythology

Zeus loved consorting with beautiful nymphs and often visited them on Earth. Eventually, Zeus's wife, Hera, became suspicious, and came from Mount Olympus in an attempt to catch Zeus with the nymphs. Echo, by trying to protect Zeus (as he had ordered her to do), endured Hera's wrath, and Hera made her only able to speak the last words spoken to her. 


Zeus was the highest ranking God       Echo, a mountain nymph




One of the most common ways we experience the Doppler effect in action is the change in pitch caused by either a moving sound source around a stationary observer or a moving observer around a stationary sound source.

Additionally, yawning and swallowing causes contraction of the muscles connected to the Eustachian tube, enabling the tube to open to small amounts of air. This allows for the equalization of pressure between the middle ear and atmospheric pressure and results in a “popping” sound in the ear. The “popping” sound results from small amounts of air entering the middle ear to balance the pressure differential with the environment. Popping is centered around the technique of popping, which means to quickly contract and relax muscles to create a jerking effect (a pop or hit) in the body. ( imitates characters being animated by stop motion- Roboting gained fame after Michael Jackson used the dance )

“popping” steps make sound

Patulous ET can cause autophony of one’s own voice and breathing sounds and aural fullness.  The eustachian tube helps to equalize the pressure in the middle ear. Having the same pressure allows for the proper transfer of sound waves. 


Embryology of the Eustachian Tube

As the skull base grows down, the angle of the eustachian tube changes gradually from horizontal to oblique. This process continues after birth and well into adulthood.  This results in elongation and angle increase of the Eustachian tube with respect to the horizontal plane during normal growth and maturity into early adulthood. The increase in the volume of the Eustachian tube has been shown to be 20 cubic mm per year until 20 years of age. 

Although much advancement has been made in understanding the physics of phonation, some misconceptions still exist in textbooks in otolaryngology and speech pathology. For example, the Bernoulli effect, which has been shown to play a minor role in phonation, is still considered an important factor in initiating and sustaining phonation in many textbooks and reviews. Tension and stiffness are often used interchangeably despite that they have different physical meanings. The role of the thyroarytenoid muscle in regulating medial compression of the membranous vocal folds is often understated. On the other hand, research on voice production often focuses on the glottal flow and vocal fold vibration, but can benefit from a broader consideration of the acoustics of the produced voice and their implications for voice communication. However, because of lack of data of the mechanical properties in each vocal fold layer and how they vary at different conditions of laryngeal muscle activation; a definite understanding of the functional roles of each vocal fold layer is still missing.


1.        Tarabichi, Muaaz; Najmi, Murtaza (March 2015). "Visualization of the eustachian tube lumen with Valsalva computed tomography: Valsalva Computed Tomography"The Laryngoscope125 (3): 724–729. doi:10.1002/lary.24979PMID 25376511.

2, Mechanics of human voice production and control. Zhaoyan Zhang  J Acoust Soc Am. 2016 Oct; 140(4): 2614–2635. Published online 2016 Oct 14. doi: 10.1121/1.4964509





Thursday, 3 June 2021

Chapter 20. Discover the high pitch voice, peer pressure and life cycle of few puberphonia boys

 Chapter 20. Discover the high pitch voice, peer pressure and life cycle of few puberphonia boys

Puberphonia is a type of voice disorder characterized by habitual using high pitched female voice after puberty in male. Based on 29 years of research work on puberphonia treatment with boys, the vital components in their lives, popularity friendship, cliques, social status, social isolation, loyalty bulling boy girl relationship and after school activities, cleanly indicates that peer power explore existing myths about creation of transgender. Voice and communication are crucial aspects of daily life for all humans. Within the puberphonia voice and communication are often brought to the forefront when the incongruence between gender identity and voice/communication style are greatest. Aspects of voice and communication are highly related to gender and culture. These include pitch, intonation, loudness and stress patterns, voice quality, resonance, articulation, speech rate, language, and nonverbal communication. Altering the aspects of voice and communication related to gender have been reported to reduce gender dysphoria while improving mental health and quality of life.
The estimated population Tamil Nadu (a state in India) estimated population in 2017 IS 79.788 million. Tamil Nadu has estimated population of 30,000 transgender people. The incidence of puberphonia in India estimated to be about 1in 900,000 population. This research paper chronicles the collaborative efforts of a team of ENT surgeons, speech language pathologist, mimicry artists, virtual reality therapist, psychologist, sex education and parenthood councilors, in cure of a puberphonia client’s vocal, physical, and behavioral transformation from a male to a female identity. It will detail the process of maintaining the client’s vocal health while adjusting pitch resonant focus, inflection pattern & articulation to create an identifiable male voice profile. In addition this research work will describe the body language and verbal communication practices that facilitate the client’s physical and behavioral metamorphosis. We have a strong desire to change the voice of transgender who like to revert to their original sex identity to live with the society.
Problems of puberphonia
When a young man is reaching the age of 16 (with some teens it starts at the age of 13 or younger) his voice must have changed to become more “manly ‘’voice –dropping down the pitch to the male voice range of tenor, baritone or bass. Adam’s apple will become widened as the system lowers anatomically ,making the vocal cord longer and the tone they produce lower(changing down from the child’s voice of about 400Hz to a man’s voice around 100Hz).
Some man do not go through this change and stay with a high pitched voice, creating a womanly voice output (around 200Hz) for them, making social encounters very uneasy for them, as their voices in high pitched women like while their appearance and behavior in a young male.
The present study provides input for further decision making.
There are many resources to help puberphonia people identify communication characteristics that may be targeted to develop more gender specific communication style. These may include vocal coaches, theater professionals, singing teachers, and movement experts. Specialty trained speech language pathologists are best equipped to facilitate overall vocal health and efficiency, in addition to behavioral changes related to voice and communication for puberphonia people. Otolaryngologists with subspecialty training in laryngology are skilled in vocal fold surgery techniques (phonosurgery) which may act as an adjunct to voice therapy. Puberphonia people may present with voice complaints related to quality change or fatigue that are unrelated to gender transition. This could be non-organic, organic, iatrogenic, or idiopathic in nature.
Etiologies of Voice Disorders / Pathology Classifications (There is considerable overlap among these three groupings )
I. No structural changes in the vocal cord
1.Disorders of voice use •
Muscle tension dysphonia Vocal Fatigue Vocal abuse/misuse Ventricular phonation Puberphonia/mutational falsetto Transgender voice Conversion aphonia
2.Idiopathic voice disorders•
Paradoxical vocal fold motion Chronic cough Above are components of Irritable Larynx Syndrome along with Muscle Tension Dysphonia and Globus sensation Subglottic stenosis Laryngomalacia
3.Systemic disease•
Influences on the larynx and voice Pharmaceutical effects Growth hormone influences Thyroid function influences Sex hormonal imbalances Rheumatoid arthritis Allergies Candida Respiratory diseases Reflux disease
4.Neurogenic voice disorders
Unilateral vocal fold paralysis Bilateral vocal fold paralysis Adductor spasmodic dysphonia Abductor spasmodic dysphonia **Essential vocal tremor **Myasthenia gravis Multiple sclerosis Huntington’s chorea **Parkinson’s disease Amyotrophic lateral sclerosis *
5.Idiopathic voice disorders
6.Paradoxical vocal fold motion Chronic cough Above are components of Irritable Larynx Syndrome along with Muscle Tension Dysphonia and Globus sensation Subglottic stenosis Laryngomalacia
II. Structural changes of the vocal folds
*Nodules Polyps• Vocal fold hemorrhage/varix• **Reinke’s edema/polypoid degeneration• Laryngitis: acute/chronic• Granuloma/contact ulcer• Congenital/acquired cysts• Papilloma• Congenital/acquired webs• **Sulcus vocalis• **Presbylaryngeus• Leukoplakia and hyperkeratosis• VF carcinoma•
Personality-related Disorders. Identity conflict:
Dysphonia secondary to difficulty in establishing individual’s personality
High-pitched falsetto in post-pubescent adolescent Weak, juvenile, thin-sounding voice of adult female Increase in fundamental frequency in male-to-female transsexual patient
We are concentrating only disorders of voice without any structural changes, mainly and only puberphonia. It is important that a comprehensive voice evaluation is completed, including voice and communication needs related to gender transition, by a laryngologist and voice trained speech pathologist prior to initiating voice treatment. Evaluation should include a thorough laryngeal examination including videostroboscopy to assess the anatomy and physiology of structures related to voice production.
Make awareness of treatment available for puberphonia. It is curable and it should be corrected. We formed a puberphonia eradication program in SIVA ENT Hospital
The Voice Evaluation Team members•
Otolaryngologist Voice pathologist singing voice specialist with few Tamil Poets/ yoga masters  Harmoniam music instrument specialist/ Neurologist Allergist Endocrinologist Pulmonologist Puberphonia and Transgender clients and activists.
Evaluation of Vocal Components•- no instrument required- record when we elicit the history.
Respiration• Diaphragmatic versus clavicular/thoracic focus Degree of upper chest/shoulder/neck tension Phonation• Qualitative disturbances Ability to maintain steady pitch Consistent versus inconsistent Resonance• Hypo/hyper nasal, cul-de-sac, etc. Pitch• Too high/too low Limited in range? Can patient vary the same? Does the voice change with changes in pitch? Intensity• Too loud/too soft Patient’s ability to vary intensity Any associated vocal changes with variation? Rate• Too fast/too slow, changes prior to evaluation, coordination w/respiration
Case study and approach to puberphonia patient
Puberphonia people may present only with voice complaints related to quality change or fatigue Evaluation should include a thorough laryngeal examination including videostroboscopy to assess the anatomy and physiology of structures related to voice production. The overarching treatment goal for puberphonia people who present with voice and communication complaints is to aid in achieving a low pitch voice in an efficient and safe manner. Treatment should be patient specific and can be accomplished through behavioral and medical/surgical intervention. Our principle of treatment UMAR.
Our aim is voice masculinization
More puberphonia males present for voice evaluation and treatment than few puberphonia females. This may be related to the Puberphonia which is not a rare disorder. We have come across many person, especially a male person having a female-like voice, and worse still, have you ever bullied or made a bad joke for his having such an adolescent voice? The person might be suffering from a more serious medical complexity. Don’t make it so difficult for the person; he is already having a hard life! If some one suffering from such a voice disorder, and is facing such awkward situations in your day-to-day life, then you are probably suffering from Puberphonia! Do not panic, as it can be cured completely, and you will soon be having an attractive voice, which everyone would love to hear!
P itch
100% of puberphonia men are identified as male by telephone. Pitch may be perceived as the most important factor for voice and subsequently gender identification. A strong marker for the perception of female voice is an average speaking pitch of 180 Hz in a range of approximately 140 to 300 Hz.The hormone induced pitch change is not always without problems and it remains unclear if it is in all cases sufficient for the speaker to be identified as male. Research supports that voice and communication should be targeted in voice therapy.With hormone therapy, final lowered pitch is achieved sometime after 1 year.
Increased 'chest resonance' is suggested as a goal in voice therapy. Achieving balanced resonance during voice production contributes to overall vocal efficiency and may play a role in the reported improvement in voice complaints for puberphonia men following voice therapy. Few reports suggest a primary role of resonance in perceptual identification of the speaker's gender. However, our study reports that a combination of both pitch and resonance are found to contribute to perceived masculinity and should be addressed.[
Puberphonia had fewer upward and more downward intonation and decreasing pitch variation. It occur while avoiding monotonicity for puberphonia men
Lower vocal intensity contributes to voice feminization, it may be considered that reducing breathiness and avoiding a soft voice may be perceived in puberphonia.
While pitch is primarily addressed through hormone therapy and secondarily by voice therapy, the other components of voice production are primarily addressed through behavioral voice therapy.
Breath of fire breathing and nasal resonant voice training are two common voice breath therapy techniques. Breath of Fire is a breathing exercise used in Kundalini yoga. It involves passive inhales and active exhales that are quick and powerful. In normal speech the vocal folds function only like a reed,whose vibration produce the vocal tones of speech. In an effort to eliminate puberphonia high pitch voice, we recommend that the puberphonia should make a breath of fire as he tackles a block with the thought that this would keep his vocal cords open and relaxed which would enable him to move more easily through the block. This is somewhat similar to the recommendation that a puberphonia make or breathe a uvula vibrating “k” or ழ (La) sound at the uvula. Such techniques can work, as they will help release wards at the level of uvula.
Flow phonation targets the balanced exhalation of airflow during voice production using respiration as the power source to achieve vocal efficiency. Nasal resonant voice therapy focuses on achieving easy phonation while experiencing the energy or vibration of sound in the nasal cavity. The combination of these techniques can work to maximize voice production targeting pitch, resonance, intonation and intensity for puberphonia men.
Data collection include questionaries’ on motivation for treatment, post-treatment experience and standardized measure of psychological symptoms, body image, self-esteem, sexuality and quality of life. It is important to disease these thoughts with all. No youngster should ever be forced to endure this kind of psychological trauma, but it is important to understand that it was this terribly devastated young mind to begin desperately (perhaps unconsciously) seeking a newer, better identity.
Discussion :
As that time of new culture of worldwide interest availability women in general were becoming increasingly sexualized. Pornography was becoming more common and explicit. Nothing in the world seemed more popular than the hyper sexual female. Even thoughts boys did not yet understand that sexuality, they see in the internet, television and in magazine that everybody loved a pretty girl. Nothing for a puberphonia boy made him acceptable as a female, so he began obsessing on the image of the other such girls and then began experimenting with feminizing himself.
Just dreaming up regularly like girls may not have indicated anything other than an unusual fascination and formal of escapism, however after dressing like a girl, he would then go out walking around town like this.
Nothing a teen boy can do will change their biology from male to female. Male will never grow ovaries and females will never grow testes and neither will ever have the actual genitalia of the opposite sex.(5). XY chromosomes will always be XY chromosomes.
Ones DNA will always be the sex you were born. One can play the part of a woman but you cannot be one unless you were born one. According to our study; 1 in 26 transgender adult later said; they regretted transiting; while others drifted into psychiatric morbidity and suicide attempts.
Society should not be catering to delusion notation that people are either trapped in the wrong body or would be better off as another sex ; instead, we should be reinforcing positive “nerd” images and encouraging them to accept their biology, since that in reinforcing reality.
When young person go through a gender transition, they take all the stress that comes with a major life change. Many biological male and female take the gendered parameter of their voices for granted. Fear of misidentification and social isolation are the common problems with transgender.(2). Male to female transit patient most often do not achieve adequate voice change through hormone therapy.
Puberphonia boys step by step change to TRANSGENDER :
A boy with puberphonia left him highly emotional insecure and prone towards bulling easily by friends relative and neighbors. The bullies in school tuned in their weakness very early and took great pleasure. As few children are not cared and look after well by parents, they felt rejected out worthless. In terms of sexuality; puberphonia boys were used sexually by older body, teachers and friends. Every time the puberphonia boy was convinced (bribed actually) to prefer oral intimacy or anal intimacy by the male partner. The puberphonia boy actually cannot say that he had recognized the sexual experiences as “trauma” per se, they just seemed exceedingly strange to him and left in him a sensation skin to being hunted. In any case, the exploitation probably at least played a role in “grooming” this sexual identity, albeit arguably unintentionally. Day after day, week after walk month after month it was the same. So desperately they want a new identity as transgender. Once a boy finds out a new identity and left he enjoys oral and anal intimacy with other male. Anal intimacy is more pleasurable as it provide a change for increasing the time of intimacy. The mechanism of action of anal intimacy is of two folds.
1. A natural sphincter constricting ring is available in the anal aperture, where the conscious sphincter action and constriction of the introduced penile shaft is carried out voluntarily. It helps in delaying the ejaculation.
2. The lower alimentary canal is a vacuum tube. It helps in suction and lengthening of the penile shaft, introduced in to the anal canal.
Some prefer anal intimacy to avoid pregnancy and AIDS and many more psychological factors.
Once someone accept identity as female, the life continue as for as possible. In the old age they are left out of society and they are dejected in life.
The puberphonia boy spent almost the entity of adulthood in a perpetual state of rejection and fear almost at every turn. He thus began turning in wards for escape. He began compulsively feminizing himself. Initially there was no consciously sexual impulse driving it, although that would change after puberty kicked it.
75% of transgender identified adult have male biology and this incidents may suggest to all that is has been (my opinion) primarily driven by sexual/ psychological the world around them. Males are biologically much more susceptible sexual imagery which has been confirmed by the fact that pornography industry was built almost entirely on male clientele. This susceptibility to the many sexual symbols in our environment, would also explain why transgender inclination have increased as society itself has become increasing sexualized.
Nothing a teen boy can do will change their biology from male to female. Male will never grow ovaries and females will never grow testes and neither will ever have the actual genitalia of the opposite sex. XY chromosomes will always be XY chromosomes. Ones DNA will always be the sex you were born. One can play the part of a woman but you cannot be one unless you were born one. According to their study; 1 in 26 transgender adult later said; they regretted transiting; while others drifted into psychiatric morbidity and suicide attempts.
On December 10, 1948, the General Assembly of the United Nations adopted and proclaimed the Universal Declaration of Human Rights, wherein Article 16 (i) states that “Men and Women of full age without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and its dissolution”. The founding fathers of the UNO are the real defenders of nature. Hence they affirmed and declared the above statement. The UNO has declared male and female only not the third gender. The so-called third gender is a new innovation of crooked persons.
Some crooked fellows have occupied highest position in over all governments and they are trying to demoralize the society, demoralizing the whole system. 70 years have passed from the formation of UNO, still we have not been achieved the 4 main purposes of its formation. The first second and fourth purposes are about peace among nations and the third purpose is lives of poor, hunger and disease. UNO must be keen to achieve its four main purposes. But, the UNO is going the other way. UNO is going beyond the objects. UNO is detracted and detached from its main object. The inspirations and Will of the Founding Fathers of the UNO must be achieved in the world and we have the duty bound to fulfill their wish and ambition and not go beyond.
Print media as well as visual media are perverted and propagate negative impact on social behavior and psychology among people. If the world is going against natural order and moral order, then there is no peace in the world. Consequently chaos and confusions will prevail.
Lastly, I am not against the protection given to the transgender or given a reservation for them in all places or the bathroom. But I want to tell that the transgender peoples are having the defect by birth and it is curable as per the experts cited reasons in Annexure. The government must take care of the transgender and given them proper care and treatment and give suitable atmosphere to live as an ordinary man or woman.
Future research:
Most people understand the bullying, exclusion, and violence that puberphonia youth sometimes face from people in their wider community. But something many people don’t know is that the pressure to look and act certain ways that teens experience from their peers can be just as damaging to their wellbeing.
There is a lack of research into transgender peoples of minority stress and resiliency particularly the impact of transition related intervention on suicidality. Trasgender,29% attempted suicide in the in life time. These findings may be may be useful in creating targeted intervention that take into accurate the alarmingly high rate of suicidality in the population. It is a social cause. Awareness is the first towards helping this great social stigma. We have to identity all puberphonia and trans genders. Those who want to come out of this social stigma; they should be helped .Particularly changing the voice to the required gender helps them. Public will target their past lives with the recognition of their voice quality. Voice of both (transgender and puberphonia) has to be corrected according to their wish. Make them to live with the parents and society. Communities seem unprepared and uneducated to smoothly integrate these people in our societies.
The purpose of this paper is to summarize the transgender have to deal with, in order to survive and merge into society, identify the main reason for the low public awareness, discuss the current situation and provide potential solution in reducing the stigma among them.
Future research in voice therapy – virtual reality:
To develop the next stage in virtual reality therapy; is modeling the aerodynamics of larynx and pharynx. A computed tomography scan of the larynx and pharynx was converted to provide three dimensional (3D) models based on the actual anatomic structure for use with a computation flow dynamics program. The model is compared to normal to determine the changes in the dynamics plays and laryngeal air flow. With the head set and sensor voice care virtual reality therapy can be given.
Statement :
Our Lord Jesus Christ has said "Who answering, said to them: Have ye not read, that he who made man from the beginning, Made them male and female? And he said: "(Mat.19:4). God created the human as male and female and also animal and botanical too.
The body constitution of a man is different from a woman. The male flesh is different from female flesh. The body of the male is having hairs but the female is not like that. The genital part of the male is entirely different from a female. God created as male and female in animals also. "Two and two went in to Noe into the ark, male and female as the Lord had commanded Noe. (Gen.7:9) We have seen male and female in Palmira tree also. The female Palmira tree gives fruit but the male Palmira tree is a barren one and it is unable to give fruits. So, nature itself is made it clear that every living creature is male and female only.
The so-called transgender, the man/woman has a defect by birth, likewise the dumb, blind and lunatic. It's important to remember that if someone is transgender, it does not necessarily mean that he or she has a "third gender." Most transgender people do have a gender identity that is either male or female, and they should be treated like any other man or woman. “The exceedingly rare disorders of sex development (DSDs) including, but not limited to testicular feminization and congenital adrenal hyperplasia, are all medically identifiable deviations from the sexual binary norm, and are rightly recognized as disorders of human design. Individuals with DSDs do not constitute a third sex. The statement points out that such gender confusion should be treated as a psychological disorder called “gender dysphasia” and is “a recognized mental disorder” in the most recent edition in Nov. 2014: of the “Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-V).”
It's important to remember that while being transgender is not in itself an illness, many transgender people need to deal with physical and mental health problems because of widespread discrimination and stigma. Many transgender people live in a society that tells them that their deeply held identity is wrong or deviant. Some transgender people have lost their families, their jobs, their homes, and their support, and some experience harassment and even violence. Transgender children may experience rejection or even emotional or physical abuse at home, at school, or in their communities. These kinds of experiences can be challenging for anyone, and for some people, it can lead to anxiety disorders, depression, and other mental health conditions. But these conditions are not caused by having a transgender identity: they're a result of the intolerance many transgender people have to deal with. Many transgender people – especially transgender people who are accepted and valued in their communities – are able to live healthy and fulfilling lives. The group is most concerned about the regimen of drugs that are given to children to block puberty. “Children who use puberty blockers to impersonate the opposite sex will require cross-sex hormones in late adolescence. Cross-sex hormones (testosterone and estrogen) are associated with dangerous health risks including but not limited to high blood pressure, blood clots, stroke and cancer.”
For many transgender people, recognizing who they are and deciding to start gender transition can take a lot of reflection. Transgender people risk social stigma, discrimination, and harassment when they tell other people who they really are. Parents, friends, co-workers, classmates, and neighbors may be accepting—but they also might not be, and many transgender people fear that they will not be accepted by their loved ones and others in their life. Despite those risks, being open about one’s gender identity, and living a life that feels truly authentic, can be a life-affirming and even life-saving decision. Transgender people should be treated with the same dignity and respect as anyone else and be able to live, and be respected, according to their gender identity.
It’s not the 'trans' people. They are not much of a problem, because they are suffering from a biological-medical condition-mostly hormonal-and they know it. Children are born with genetic heritage all across the spectrum, most of which are suitable for membership inhuman social civilization. A youngster's gender identity normally results from this natural selection process.
The main forces behind this are:
i. False "Feminism".
ii. Aggressive Atheism disguised as "progressive science".
iii. Homosexuality and all other forms of rejecting Natural Sexuality;
iv. Sexualized persons. These people’s activities are always sex and sex is their hidden agenda
It is not that we'd hate homosexuals and others. 'Trans' people, for instance, suffer from biological-medical conditions - and little is known of abuse from their side. But LGB (lesbian, gay, bisexual) people (who only use the 'trans' people as decoy, because they do have a good reason for how they are) are so arrogant in their narcissistic-exhibitionist ways of "pride" parades etc. "Pride" - for what? Is it for being aside of Nature?
So sad that children are not allowed being children. They are either male or female there is no transgender child in the world. "And God created man to his own image: to the image of God he created him: male and female he created them"(Gen.1:27). And hence there is male or female no in between. Their idea of gender identity is so scrambled, that God gave them over to a reprobate mind.
Just because a boy likes to have long hair, doesn’t mean he is suddenly a girl. And just because a girl likes to play outside, climb trees, and run around, doesn’t mean she is a boy. The adults who adopt the transgender lifestyle need counseling and recovery, not encouragement to continue down a dark path.
The outcome of this study is three fold :
1. To illustrate the powerful psychological force that shaped puberphonia to transgender on their identity or inclination.
2. To explore the serious dangerous and implications of promoting transgender in children.
3. To illustrate a non-invasive method of treating puberphonia.
Limitations of this study :
1. This study is concentrating on puberphonia. We have worked on 68 cases of puberphonia. We have invented a new method of treatment for puberphonia.
2. This study has to be done world wide
3. These study it self-limited by sexual privacy revealing.
4. More work has to be on the post-traumatic stress reaction of transgender.
5. Step by step, the other causes that initiate the transition should be identified.
6. Speech therapy needs virtual reality therapy with simulation.
The strength of the study :
1. The society should help transgender at the same time stop developing new trans genders
2. The post-traumatic stress reaction of transgender; 80% of the transgender die early.
3. In puperphonia to genetic and hormonal causes are completely ruled out.
4. Voice analysis in puberphonia and transgender are recorded and almost have similar pattern.
References :
1.Adams noah, histomimeaya, and moody Cherie transgender health April 2017, 2(1): 60-7 5vol 2 issue 1 April, 1 2017. Varied report of adult transgender sociality synthesizing and describing the pees reviewed and gray literature.
2.Cho.w.hong,j,and park .h real-time ultrasonography assessment of true vocal fold length in professional singers.
3.Emily many, North Eastern University, Boston, Massachusetts.USA
The male to female transgender voice most salient voice parameters in perceived – gender identification 2014 publication.
4.Hatagak is Ge, karasan, cook j, sehlossm, davisgh
Structure in children Int.J.Pediatrotorhinolaryngl 2003;67(4) 373-81
5.Narayanareddy D.Life (Youir –in Tamil language) Vikadan publishers Nov 2012.757 Anna road, Chennai- 600 002.
6. SudhakarVaidya 1 and G. Vyas1(2006).Puberphonia: A novel approach to treatment .Indian J Otolaryngol Head Neck Surg. 2006 Jan; 58(1): 20–21.
7. Su.M.Eyeh, T.H.Tan, ctetal.Measurement of adult vocal length J.Laryngolotol 2003;116:
8. Peer Pressure and ‘Transgender’ Teens, Sept. 9, 2018 4:25 pm ET, WSJ Live, Ideologues try to suppress a study on the increasing prevalence of ‘rapid onset gender dysphoria.’ By Jillian Kay Melchior.
9.Fast Track Treatment for Puberphonia - Lupine Publishers › pdf › SJO.MS.ID.0... 05-Feb-2020. Puberphonia is not a rare disorder

Tuesday, 1 June 2021

Learned Helplessness in puberphonia treatment


Learned Helplessness in puberphonia treatment

Puberphoniaia a learned helplessness is a behavior pattern involving a maladaptive response characterized by avoidance of challenges, negative affect, and the collapse of problem-solving strategies when obstacles arise. Three components are are playing a role in puberphonia boys mind, namely contingency, cognition, and behavior.

Contingency is is a creative idea that there is an identifiable relation between their voice and the environmental response, In our pubetphonia research, contingency is more often operationalized as its converse— uncontrollability—so that when an puberphonia boy speaks, there is no identifiable relation with a specific response. Cognitions are also necessary. These are thought of as the way one understands and explains contingency or lack thereof. How he explain environmental contingencies leads us to the third component of learned helplessness—behavior. Thus, learned helplessness exists in a situation in which there is no observable contingency and in which he expects that this uncontrollability will continue and behaves accordingly, such as by quitting.

Origins Of The Theory- The Elephant Rope A Motivational Story 



Elephants grow fast, of course. Before long, those cute babies are lumbering giants. But here's the thing: That same thin rope is all that's needed to keep them secured. They think the rope can still hold them, so they never try to break free. Moral of the story: No matter how much the ENT Surgeons tries to bring achieve the high pitch voice puberphnia boys, always continue with the belief that what you want, to achieve high pitch voice to low pitch voice is not possible. Believing you can become successful is the most important step in actually achieving it.

Our researchers applied the theory topuberphonia, it became clear that puberphonia responses are considerably more complex. Early results were generally supportive of the theory while continuing to raise new questions.

 Why” when something happens and noted that their answers can often lead to specific and predictable reactions to events. We now proposed, a puberphonia person need only expect that an outcome is noncontingent for learned helplessness to result. How the expectation of noncontingency is arrived at is less important, whereas causal attributions of why the outcome is noncontingent become more important in predicting the nature of subsequent deficits. These adjustments in the theory proved more powerful in predicting behavior.

Processes In Learned Helplessness

Uncontrollability seems to be associated with increases in negative emotions such as anger, anxiety, and depression, reduction in observable aggression, and increased arousal. Self-esteem is particularly susceptible to learned helplessness. Research findings imply that individuals who experience noncontingent outcomes may become increasingly likely to display the helpless pattern. We have demonstrated that failure to avoid the aversive event was associated with subsequent failure at a cognitive task, and that failure at a cognitive task was associated with failure to avoid the aversive event, effectively establishing “cross-modal helplessness”—generalization from one type of task to another. This was crucial to the advancement of the theory.

These findings continue to support the idea of helplessness as a coherent set of deficits, rather than simply a task-specific problem. Individuals who demonstrate helpless patterns make statements suggesting that they believe themselves to be personally responsible for failure, to attribute their failures to stable circumstances, and to state that these characteristics encompass their whole selves. In other words, they seem to believe that they have failed because they are stupid, they are going to remain puberphonic, and everything they do is stupid—controllability, cognitions, and behavior. This pattern is often referred to as “explanatory style,” and much research has gone into supporting the idea that humans tend to use a particular style to explain both good and bad events.

Human beings are quick to adapt to new circumstances—a quality that has helped us survive and thrive. But it also means that the positive things that initially make us happier soon become our new normal. We feel that perhaps it is adaptive for an individual to stop responding in the face of failure and that failure to solve the problem, not uncontrollability, underlies the helplessness phenomenon.

We demonstrated that, whereas failure resulted in decreased mood, it was the condition of uncontrollability that resulted in task performance deficits. Their data support the idea that participants can distinguish uncontrollability and failure and that passivity as a behavior is a deficit, rather than an appropriate response.

Who Does Learned Helplessness Affect?

Puberphonia exhibiting this pattern have difficulty acquiring and demonstrating cognitive skills in the face of adversity. They demonstrate dramatically poorer outcomes in a wide variety of domains, including social relationships, sports, moral development, and academics. It is apparent that a child’s orientation toward challenging tasks has a compelling impact on the child’s future adjustment in a variety of areas.

There is very little evidence at this point describing the antecedents of learned helplessness. Application Of The Theory

We have also learned through several different studies that learned helplessness can be unlearned.

What is learned helplessness in puberphonia?

Learned helplessness in puberphonia is a state that occurs after a person has experienced a stressful situation repeatedly. They come to believe that they are unable to control or change the situation, so they do not try — even when opportunities for change become available.

we explore the state of learned helplessness in puberphonia for some people, it is linked with post-traumatic stress disorder (PTSD) and suggest some ways to overcome it.


They have “learned” that they are helpless in that situation and no longer try to change it, even when change is possible.

Once a person having this experience discovers that they cannot control events around them, they lose motivation. Even if an opportunity arises that allows the person to alter their circumstances, they do not take action.

Individuals experiencing learned helplessness are often less able to make decisions.

Learned helplessness can increase a person’s risk of depression.

becoming passive in the face of trauma

difficulty learning that responses can control trauma

can increase in stress levels

low self-esteem

low motivation

low expectations of success

less persistence

not asking for help

ascribing a lack of success to a lack of ability

ascribing success to factors beyond their control, such as luck

Why does learned helplessness affect some people and not others?

A person’s experiences can increase their risk of developing learned helplessness.

It typically begins after experiencing repeated traumatic events, such as adulthood abuse.However, not everyone who goes through these things will develop learned helplessness.Explanatory styles also play a role in its development. An explanatory style is a person’s way of explaining an event to themselves. People with a pessimistic explanatory style — causing them to view negative events as being unavoidable and resulting from their own shortcomings — are more likely to experience learned helplessness. People with an optimistic explanatory style are less likely to do so.

How to overcome learned helplessness in puberphonia

People with learned helplessness can overcome it. The most common treatment is therapy, especially cognitive behavioral therapy (CBT). CBT helps people overcome these types of challenges by changing how they think and act.

Receive support and encouragement

Explore the origins of learned helplessness

Develop ways to decrease feelings of helplessness

Identify negative thoughts that contribute to learned helplessness

Identify behaviors that reinforce learned helplessness

Replace thoughts and behaviors with more positive and beneficial ones

Improve self-esteem

Work through challenging emotions

Address instances of abuse, neglect, and trauma

Set goals and tasks for themselves

We suggest that all nasal resonance breathing exercise can prevent learned helplessness in puberphonia and it is possible to overcome puberphonia with UMAR therapy and lifestyle changes.