INSTABILITY OF VOICE IN ADOLESCENCE - PATHOLOGICAL CONDITION OR NORMAL DEVELOPMENTAL VARIATION

Pediatricians often send adolescents with dysphonia to the otorhinolar yngologist's office to find the reason for their hoarseness. The aim o f this study was to identify the main characteristics of adolescent vo ice and to determine which characteristic (variable of voice analysis) can distinguish normal variations of voice development from pathologi c disorders. Study design: On the basis of history, indirect laryngosc opy, and stroboscopy, 51 adolescents (22 boys, 29 girls) from age 10 t o 17 years were divided into four subgroups: candidates for singing le ssons without voice problems, subjects with mutation voice disorders, subjects with functional dysphonia, and subjects with vocal cord nodul es. Voice analysis by Multi-Dimensional Voice Program (Kay Elemetrics) evaluated the fundamental frequency, the variability of pitch and amp litude (loudness), and the presence of noise in the analyzed voice sam ple of each of the subjects. Data were analyzed with the SPSS+/PC Stat istical Program. Results: All mean values of variables that describe v ariability of pitch and amplitude were abnormal in boys and in girls, with greater abnormality among boys. The variability of loudness and s pecifically the variability of pitch were abnormal in a majority of su bjects. A significant negative correlation between age and fundamental frequency was stated in boys only and between age and variability of amplitude in girls only. Variables that express variability of pitch a nd amplitude correlated positively between themselves. No significant differences were found between the first subgroup (candidates for sing ing lessons), which represented a normal population, and the other thr ee subgroups (subjects with mutational disorders, functional dysphonia , and vocal cord nodules). In addition, no significant differences wer e found between the first three subgroups (subjects without voice prob lems and subjects with functional voice disorders) and the fourth subg roup (subjects with vocal cord nodules: organic lesion of laryngeal mu cosa). Conclusions: According to this study, the main characteristic o f adolescent voice is the instability of amplitude (loudness) and spec ifically the instability of pitch. Female voices appear more stable th an male voices. No single variable of performed voice analysis can dis tinguish normal variation of voice development from pathologic disorde rs. The reason for this instability can be attributed to more gradual adaptation of the afferent and efferent nervous control to the rapid g rowth of the phonatory, respiratory, and resonatory organs. In the gro wing speech apparatus, optimal phonatory patterns can be created; ther efore adolescence is an ideal period for treatment of functional voice disorders.