Clinical Characteristics and Prognosis of Puberty-related Abnormal Voice

Objective: To explore clinical characteristics and prognosis of puberty-related abnormal voice.

Methods: This study included 63 pubertal children complaining of abnormal voice, including 54 boys and 9 girls, with an average age of 14.2±1.7 years. The clinical data were analyzed, including basic characteristics, voice quality, laryngoscopic manifestations, treatment, and prognosis. Simultaneously 63 healthy subjects were paired to compare differences in voice.

Results: Puberty-related abnormal voice in all the patients characterized as abnormal pitch. Thirty-three boys (61.1%) showed an undescended pitch, and 21 (38.9%) had an unstable pitch, onset at 12.4±1.3 (8-15) year old. Fifty boys (92.6%) and their guardians had no accurate understanding, three favored previous voices, and one admired female voice. Seven girls had abnormal descended pitch, with four having abnormal levels of androgens or pituitary hormones. The fundamental frequency (F0), jitter, and shimmer in boys were higher than those in healthy controls (p<0.01), and the maximum phonation time (MPT) was decreased (p<0.01). The F0 and MPT in girls were lower (F0 p<0.01, MPT p=0.01). Immediately after voice therapy, boys showed significant improvement in pitch and voices in 90.7% of the patients ultimately improved, which only occurred in two girls.

Conclusion: Puberty-related abnormal voice in children mainly characterized as abnormal pitch. Boys have higher morbidity of undescended or unstable pitch, with children and their guardians often lacking correct understandings. However, their voices may return normal after therapy. Girls often present with abnormal descended pitch, which may be related to abnormal hormone levels, making it difficult to achieve good prognosis.