Two cases of mutational voice disorder without consciousness of high pitch

Adolescent voice change is generally said to be completed by around the age of 14. Here we report two cases of patients examined at our hospital who became aware of an abnormally high pitch in their voice for the first time in their twenties when indicated by third parties. Both cases had already completed puberty and showed no organic laryngeal abnormality. Although they demonstrated higher than the average normal male pitch, they had only minimal consciousness of their abnormally high voice. On first examination, we employed the Kayser-Gutzmann method, clearing of the throat, and the siren method to guide the patients' voice to a lower pitch. We next performed voice training from vocalization, at the lower pitch, of a sustained vowel through a short sentence, and autofeedback of the voice was carried out. This training was performed at a frequency of once every one to two weeks. With both patients, it was possible to lower the vocal pitch during the first training session, but achieving a lower pitch in everyday conversation took some time. These results suggest that changes in the patients' social environment at school, e.g. respect for their individuality, had delayed their consciousness of their abnormality and, as a consequence, delayed their seeking a diagnosis of their condition.