Voice changes are a familiar part of puberty, especially in males. Hormonal fluctuations during this period cause the vocal cords to lengthen and thicken, while the larynx grows and matures. Together, these changes typically lower the pitch of the voice, leading to a deeper sound. In a small number of individuals, however, this transition does not stabilise fully, and a higher-pitched voice continues into late adolescence or adulthood. This persistent higher pitch is referred to as puberphonia.
Functional voice condition
Puberphonia is classified as a functional or mutational voice condition. According to Venkatakarthikeyan C., senior consultant, ENT and Head and Neck Surgery, Apollo Hospitals, Chennai, puberphonia reflects a pattern of voice use rather than a disease. This means that the vocal cords and laryngeal structures are usually anatomically normal, and there is no underlying condition affecting the voice box.
“Puberphonia is generally considered psychogenic in nature,” says Haripriya G. R., senior consultant, ENT, Kauvery Hospital, Vadapalani, Chennai. “Emotional factors such as stress, difficulty adjusting to pubertal changes, increased responsibilities, overprotection, or delayed secondary sexual development can influence how the voice is habitually used.”
She adds that physical contributors may be present in some cases. These can include reduced coordination between breathing and voice production, weakness of laryngeal muscles, or minor structural variations including incomplete fusion of the thyroid cartilage. However, these are usually subtle findings rather than clear abnormalities.
Highlighting growing awareness of the condition, M.S. Kumaresan, ENT surgeon, has recently published a book on puberphonia, detailing clinical approaches, long-term outcomes from over 1,650 cases, and AI-based voice assessment and therapy.
Clinical evaluation, treatment
In general, doctors say, the condition does not affect physical growth, and medical support is needed only if the voice leads to strain, fatigue, or communication difficulties. Men sometimes face self-esteem issues and their confidence is affected if their voice does not sound as expected, and this can affect their professional lives, doctors note.
Assessment of puberphonia focuses on understanding how the voice is produced. “Diagnosis is made through detailed speech and voice assessment,” Dr. Haripriya says.
Speech-language therapists evaluate pitch, loudness, resonance, and breathing patterns to identify habitual voice use. More recently, AI based voice assessments use acoustic analysis of pitch, frequency patterns, and voice stability to help determine whether a voice is puberphonic or within the normal post-pubertal range.
A laryngoscopic examination is routinely performed to confirm that the vocal cords are normal in structure and movement. This helps rule out conditions such as nodules or polyps. Clinical history and psychosocial factors are also reviewed as part of a comprehensive evaluation.
Voice or speech therapy is the primary and most effective treatment for puberphonia. Therapy is delivered by trained speech-language pathologists through guided exercises to help individuals access a more comfortable and stable pitch. Therapy also focuses on improving resonance, breath support, and coordination of laryngeal muscles.
“Most cases respond very well to voice therapy alone,” says Gowri Shankar, senior consultant, ENT, SIMS Hospital, Chennai. “Surgical treatment is considered only in very rare and resistant cases where voice therapy has not produced results.” In these exceptional situations, surgical options may include thyroplasty procedures (voice restoration surgery), which alter the effective length of the vocal cords to change pitch. Other rarely-used procedures include injection laryngoplasty and crico-hyoid approximation.
Specialists reiterate that puberphonia represents one of several natural variations in voice development. They emphasise that puberphonia does not automatically reduce quality of life. Many individuals live comfortably with the condition and do not feel the need for intervention. Clear information and appropriate guidance allow individuals to make informed choices about support based on their own communication needs and comfort.
