Wednesday, 9 June 2021

Chapter 22 Puberphonia differentiate “spiritually naked" and “physically naked”


 Chapter 22

Puberphonia differentiate “spiritually naked" and “physically naked”

 “The larynx is a sexual organ, because it’s very different between one sex to the other and that has to do with how much testosterone there is compared to other hormones that balance it out,” Titze told Fatherly, adding that testosterone levels shape the length and musculature of the vocal folds, which vibrate to produce sound and ultimately dictate pitch.

Puberty and adolescence are two terms interlinked to each other representing certain changes and period of such changes. Puberty refers to the physical changes leading to sexual maturity in a boy or a girl. Adolescence refers to the transition period when psychological and social changes take place in a boy or girl.  Puberty is the reason for the adolescence and this period may vary from one person to another. During puberty, surprising cracks and unexpected squeaks can signal changes in your voice. Your adolescent's relationships with others

In male adolescent begins to struggle for independence and control, many changes may happen. The following are some of the issues that may be involved with your adolescent during these years:

·         He wants independence from parents.

·         Peer influence and acceptance is very important.

·         Peer relationships become very important.

·         He may be in love.

·         He may have long-term commitments in relationships.

Creation of Adam's apple in male and breaking of voice.

Sex is identified and recognized and got ashamed of one’s nakedness

 Adam’s apple: The protruding part of the throat is called Adam’s apple. It is the enlarged voice box or larynx which gets enlarged and visible from outside in boys at the onset of puberty. Adam's apple in your throat will start to become more noticeable. This makes the voice of boys hoarse.  The larynx, specifically the laryngeal prominence that joins the thyroid cartilage, in the human throat is noticeably more prominent in males and was consequently called an Adam's apple, from a notion that it was caused by the forbidden fruit getting stuck in Adam's throat as he swallowed it.  increasing in prominence as a secondary male sex characteristic in puberty, It is a secondary sexual characteristic: meaning it appears around the time of puberty and helps distinguish between the sexes, as it is more prominent in men than it is in women. The increase of the laryngeal prominence takes place during puberty and is logically thought to play a role in the voice maturation that also occurs in this period. However, no work has yet been done to prove this relationship decisively, only small reports of cadaver studies. They become aware of their "nakedness" and make fig-leaf clothes, and hide themselves when God approaches.

It's interesting to note that Adam and Eve made themselves coverings with the appearance of voice/ Adams apple. After eating the forbidden fruit the eyes of both Adam and Eve were opened, they now knew they were naked, and immediately after formation of Adams apple the Adams voice break and changed. This made them to recognize their sex. they made coverings for themselves. This verse gives us some idea as to why they decided to sew leaves together for clothing: They understood their condition, which was both "spiritually naked" and physically naked, and they made a vain attempt to cover what they had done by fabricating some rudimentary clothes out of materials that were readily available to them.
What does it mean when a guy has a high pitched voice?

The most important secondary sex characteristic in humans is the deeper voice. Puberty, with its voice changes among other things, can be a stressful time for teens, but understanding more about the process can help everyone cope with the situation. If he is concerned about how his voice sounds, you can reassure your son that the squeaks and changes are normal growing pains and that they won't last forever. The good news is that when his voice changes, he'll be getting the growth spurt he has been wishing for.

 Our study is the first to investigate attributions of infidelity as a function of sexual dimorphism in male and female voices. We found that men attributed high infidelity risk to feminized women's voices, but not significantly more often than did women. Our data suggest that voice pitch is used as an indicator of sexual strategy in addition to underlying mate value. Voice changes do not happen in a vacuum. Increases in testosterone during puberty make many changes in the body, not just to the voice.

However, the timing of the voice changes during puberty is significant because it does so at a certain point during the overall changes that are occurring. Voice changes happen when boys are between Tanner stages 3 and 4.1

The Tanner stages describe the physical changes in a boy's genitalia during puberty. Your doctor assesses your son's Tanner Stage, so feel free to ask where your son is at—puberty-wise—after his next checkup. It may give you an indication if a voice change is on the horizon.

The age at which voice changes begin varies widely between boys. Most often it begins between the ages of 12 and 13 and the changes are mostly complete after ages 15 to 18.

When your son's voice begins to change, this often marks the beginning of his “growth spurt.” This growth spurt is a time during adolescence where height increases rapidly.

Once boys voice stops changing, his growth spurt starts to decrease. This process can last two to three years.

At birth, boys’ and girls’ vocal folds are similar lengths, measuring about 2 millimeters long, but they continue to grow as the child grows. Girls' vocal folds grow 0.4 millimeters in length each year, but boy's vocal folds grow 0.7 millimeters in length for the same time period – almost twice as much.

This growth eventually slows down, leaving girls with a maximum vocal fold length of 10 millimeters and boys with a length of 16 millimeters. A longer vocal fold means a deeper voice, which is why males tend to have a deeper voice than girls.

Changes in the larynx are related to the increasing amounts of testosterone in boys during puberty. The increase in testosterone leads to a lengthening of the cartilage of the larynx and of the vocal folds, as well as the thickening of the vocal folds.


Unlike the boys (where the most significant growth in the larynx is front to back), in a girl’s larynx, the most significant growth is top to bottom. This means her pitch range will not change much, although her gear changes will almost certainly move. The biggest change you’ll hear is in her vocal weight and the timbre of her voice.

Study History

Creative legend Brothers, film composer, singer, ... Widely regarded as one of the greatest Indian music composer,... as well as music group headed by his elder brother  At the age of 14,  the junior brothers joined the musical troupe owned by his elder brother, for singing in child voice with the seniors in adult male voice. 


Four National Awards, 19 Filmfare awards, a Padma Bhushan and innumerable classics that placed Indian cinema on the global map,  innocent Kamal Haasan, then just four years old , Veteran Payback singer MS Rajeswari given voice to Kamal Hassan. A brilliant performance

The stages of voice change in puberphonia

There seem to be four stages of change for girls, matching their menarcheal state. For singing and drama teachers it helps to know how these might manifest:

Stage I: Prepubertal. Average age 8-10 or 11

Listen for their average speaking pitch – Stage I girls will speak around Middle C or D (C4 or D4) although there can be variations of up to a third either side. The quality of the sound is clear and childlike with no apparent changes or breaks

Stage IIA: Pubescence/Pre-Menarcheal. Average age 11-12 or 13

You may notice the first signs of physical development including increased height and breast development. Their average speaking pitch drops a little to B3 or C#4, although conversely, their singing may start to suffer as some girls lose their lower notes.

During this stage, the arytenoid cartilages and the muscles that close them may be growing at different rates. This causes temporary problems with closing at the back of the vocal folds, so there may be breathiness in the tone. The breathiness can occur across the pitch range and may cause problems with volume, especially in the middle and upper range. Despite the breathiness, a girl’s voice quality can become thicker or slightly weightier during Stage IIA

Stage IIB: Puberty/Post-menarcheal. Average age 13-14 or 15

Again, the girl’s average speaking pitch may drop, this time to between A3 and C#4
The lower pitches can feel more comfortable to sing, and the sound is more mature. Be careful at this stage not to keep her singing solely in the lower register (even if she likes it) as her voice will not yet be settled enough to produce volume and weight on the lowest notes. Keep working the girl’s range, even if you let her “sit” at the lower pitches more often.

The sound can still be breathy and the range can move up or down, or shorten dramatically, or change by the week! You’ll find it helpful to monitor each girl’s voice frequently during this stage – make it part of the lesson to find out how everyone is doing.

Often girls have a more full-bodied sound in the lower register but shift into a breathier sound higher up. There may be noticeable gear changes at G4 to B4 and again at D5 to F#5

Stage III: Young adult female/Post-menarcheal. Average age 14-15 or 16

Things start to settle down in Stage III – her vocal range may increase again and the tone is more even across the range. You may also notice that there is more ability to sing comfortably lower AND higher.

Male puberphonia voice change can be characterised by

1.     Increasing of average speaking pitch area (mean speaking fundamental frequency)

2.     Voice “cracking” and abrupt register “breaks” (abrupt voice quality changes)

3.     Increased breathiness, huskiness, or hoarseness in voice quality

4.     Decreased and inconsistent range capabilities (tessitura tends to fluctuate)

5.     Uncomfortable singing or effortful and delayed starting sound (note onsets)

6.     Heavy, breathy, “rough” tone production and/or colourless, breathy, thin tone quality

7.     Insecurity of pitch intonation.

Although voice change in females is not as dramatic as that observed in males, it does occur. In comparisons of male and female adolescent voice change, many characteristics are found in both sexes.”

Voice pitch, in particular, has been associated with indirect measures of reproductive fitness in both men and women—men with “masculine” low-pitched voices and women with “feminine” high-pitched voices tend to be rated more attractive and have more sexual partners. The deep timbre of a male voice may sound attractive, but low-voiced men actually tend to have lower sperm counts, a new study says. Multiple studies have found that women usually favor masculine features, such as prominent jaws, high muscle mass, and low-pitched voices. The theory is that these traits signal a high-quality mate—for instance, it's been proposed that masculine men generally have more robust amounts of sperm. But the new research revealed that, while deep voices are attractive to women, low-pitched men actually tended to have lower concentrations of sperm in their ejaculate.

Voice analysis

Voice recordings were analyzed using the free voice analysis software PRAAT version 5.2.35 [56]. For each voice recording the pitch of each of the first four vowels ("a", "e", "i", & "o") was extracted, and an average pitch calculated across the four vowels. The vowel "u" was not included in the analysis because of the tendency for participants to intonate this vowel with a downward inflection. PRAAT calculates pitch using a noise-resistant autocorrelation method. We used PRAAT's standard settings: pitch floor of 75 Hz and ceiling of 600 Hz, window length 0.04 s and time step of 0.01 s. There were no significant relationships between voice pitch and men's height (r = −0.027, P  =  0.850), weight (r  =  0.018, P  =  0.896), testes volume (r  =  0.031, P  =  0.826), or age (r = −0.167, P = 0.227) so these variables were not considered further.

7 Sneaky Things Your Voice Can Predict About Your Personality and Health

It's not just what you say—it's what you sound like when you say it.

Your authoritativeness

 Those who were given more power raised the pitch of their voices more, varied how loud their voices were, and became less monotone. This is just one of the bizarre things you never knew about your own voice.

Your marriage’s stability

Researchers recorded couples in marriage therapy sessions for two years and then used a computer to analyze voice features like jitter, loudness, and pitch in a study  Looking at the couples’ marital statuses five years later, researchers found that a computer’s analysis of tone of voice was better at predicting whether the relationship got better or worse than an analysis of the words therapists used to describe the sessions. Plus, the way you speak to your partner is one way to have a happier marriage.

If you’re “just friends”

When talking to someone they’ve been romantically involved with for less than a year, people tend to sound sexier and more pleasant than when talking to a same-sex platonic friend. The differences were obvious enough that independent raters were able to identify if the caller was talking to a friend or lover. The researchers say this might be because people change their voices to communicate their relationship status.

Your career success

Vote for political candidates with lower voices, regardless of the nominee’s gender. The researchers stress that their findings are correlation—not causation—and done in a lab setting, respectively. But a lower voice could (wrongly or rightly) signal strength and trustworthiness to listeners. If your job calls for giving presentations.

Your trustworthiness

Rate  the voices on personality traits like trustworthiness and dominance. While the study couldn’t verify how accurate the ratings were, the researchers found that most people rated the voices similarly. For instance, men who raised their pitches were seen as more trustworthy, while women whose voices went up at the end of a word were seen as less trustworthy. Although you can’t change your voice, you can adopt these habits that make people trust you.

Your fertility

Women’s voices are higher pitched before ovulation than when their fertility is low. Researchers think men have evolved to find higher-pitched voices more attractive because feminizing hormones and youthfulness are associated with indicate high fertility.

Your height

Tall people typically have larger lower airways, including lungs, which gives them a lower voice than shorter people usually have, the researchers say. Voice out these bizarre ways your height affects your health.

1. J Speech Lang Hear Res2006 Apr;49(2):448-59. doi: 10.1044/1092-4388(2006/035).Voice training and therapy with a semi-occluded vocal tract: rationale and scientific underpinnings

Ingo R Titze 1PMID: 16671856 , DOI: 10.1044/1092-4388(2006/035)

2.  Gangai  Amaran an Indian music composer, singer, lyricist, writer, film director and actor interview with Chithra Lakshmanan in Touring talkies YouTube channel, "Illayaraja: Gangai Amaran get together again". Behind woods. 12 March 2005. Archived from the original on 24 July 2012. Retrieved 11 March 2012.


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