The concept of “mutation” or “breaking voice” means its age-related physiological changes. This condition is common in both girls and teenage boys. The age range of the mutation period is 13-15 years. Normally, the transformation of a child’s voice into an adult takes from 6 months to 1 year. In case of violation of the timing, pace or distortion of the dynamics of age-related changes in the voice, they speak of mutational dysphonia. Pathological mutation often occurs in boys, this is due to the influence of male sex hormones on the growth and development of the larynx. The incidence of mutational dysphonia is 6-24%.

The mutation period is critical in the development of vocal function. At this time, under the influence of hormonal regulation, serious morphological changes occur in the organs of voice formation. Any stressful influences for the body can lead to the breakdown of a physiologically occurring mutation and the formation of persistent dysphonic disorder. Violations of the voice during puberty are polyetiological, their causes may be:

1. Diseases of the vocal apparatus. Infectious and inflammatory processes of the upper respiratory tract, arising at the stage of mutation, are the most frequent triggers of dysphonia. The greatest danger is represented by recurrent laryngitis and laryngotracheitis .
2. Overstrain of the voice. The development of persistent phonation disorders during the mutational period may be associated with non-observance of the rational regime: large vocal loads, forced singing, ignoring the physiological capabilities of the child’s voice. Functional dysphonias are especially common in children who practice vocal.
3. Neuropsychic disorders. Asthenic syndrome , emotional and mental shocks, increased anxiety in children often underlie dysfunction of the vocal muscles, discoordination of phonation and respiration. Also, mutational dysphonia is caused by the habit of adolescents to constantly raise their voices to others, screaming hysterically.
4. Endocrine Disorders. Improper functioning of the endocrine glands (pituitary gland, gonads, adrenal glands) causes premature puberty . In this case, a rough male voice may appear in the boy, even in the home age.
5. Sensory disturbances. Decreased physical hearing , undeveloped ear for music, the lack of formation of strong connections between the speech-motor and auditory analyzers lead to the fact that adolescents cannot correctly rebuild their voice, achieve comfortable sensations during phonation. In such conditions, the pathological method of voice leading is fixed.

Some researchers are of the opinion that mutational dysphonia develops mainly in adolescents from single-parent families, who more often hear the mother’s speech and involuntarily adjust their voice to the female pattern. However, this point of view has not been reliably proven and is refuted by other observations.

Mutation is a physiological phenomenon. It is associated with the rapid growth of the larynx during adolescence. In girls, the larynx increases mainly in height, the vocal folds are lengthened by 1/3, the voice decreases slightly (by 0.5-2 tones), and evolves smoothly. In boys, the larynx grows both vertically and horizontally, the length of the vocal folds increases by 1.5 times, and the pitch of the voice decreases by an octave. Mutational Dysphonia symptoms classification

With the pathological nature of the mutation under the influence of the above reasons, the coordinated activity of the internal and external muscles of the larynx is disrupted. The vocal folds vibrate alternately, do not close, forming a triangular slit. The articulating and facial muscles are tense. There is a mismatch between breathing and phonation, which leads to a violation of voice formation by the type of mutational dysphonia.

Mutational dysphonia can develop in various ways. Depending on the timing of the onset and the characteristics of the course, the following types of pathological mutations are distinguished:

• Premature . The change of a child’s voice to an adult occurs at the age of 8-10 years. Early mutation is associated with premature sexual development.
• Late. Begins 2 or more years later than normal mutation. At the same time, the size of the larynx corresponds to adult parameters, but the voice remains childish. It occurs in people suffering from endocrinopathies, neurological disorders, as well as singers who use falsetto for a long time.
• Prolonged (prolonged, incomplete). Despite the normally proceeding puberty, the timbre transformation does not occur. The grown man continues to speak in a high, sometimes squeaky voice. The reason for this mutational dysphonia is the lack of coordination between breathing and the vibration of the vocal folds.

The most frequent subjective complaints of patients with mutational dysphonia are reduced to tension and rapid fatigue at the time of speech, hoarseness of the voice, up to its disappearance – aphonia . The voice can have a constantly high pitch or break from a high register to a low register. There is a dry and sore throat , pain during phonation, a constant desire to cough up. Sometimes, against this background, mutational laryngitis develops.

The main symptom of a late and prolonged pathological mutation is the inconsistency of the voice with age. As a rule, this is expressed in the preservation of falsetto in young men and men with anatomically “adult” larynx. Sometimes mutational dysphonia is accompanied by neuropsychic changes: increased nervous excitability, emotional lability, rapid physical and mental exhaustion.

Mutational dysphonia directly affects quality of life. Voice disorders negatively affect the communicative side of communication, narrow the range of social interaction. Ridicule and mimicry from peers contribute to “withdrawal”, self-isolation, the formation of such traits as silence, isolation, a sense of inferiority, vindictiveness.

A pathological mutation can become an obstacle to building a career related to professional voice: a vocalist, actor, announcer, teacher, etc.

Mutational dysphonia refers to interdisciplinary problems requiring the participation of phoniatricians and speech therapists in its solution . There are no clear diagnostic standards, the clinical minimum includes an instrumental examination of the larynx and an assessment of voice function: Mutational Dysphonia symptoms classification

• Laryngoscopy . An objective endoscopic picture is characterized by hyperemia, thickening, swelling of the vocal folds, increased secretion of mucus. During phonation, the folds do not close, a so-called “mutational triangle” or oval is formed.
• Video stroboscopy . Dynamic examination of the vocal folds allows you to assess their mobility. Mutational dysphonia is characterized by inconsistent, different-amplitude fluctuations.
• Electroglottography . Allows you to objectively assess the degree of closure of the vocal folds during phonation. The contact ratio indicates incomplete closure of the glottis.
• Phonetography . Voice recording and computer acoustic analysis are performed. The minimum pitch and pitch frequencies are higher than those for postmutational stabilization.
• Speech therapy diagnostics . Includes assessment of strength, sonority, timbre of voice, research of phonation respiration. When listening to a teenager with mutational dysphonia, phonation instability, diplophony, and discoordination between speech breathing and vocal presentation are noted.

The directions of treatment and correction work depend on the reasons that caused the mutational dysphonia. In case of endocrine disorders, first of all, medical intervention is required. In other cases, restorative work is carried out in several directions: psychotherapeutic, pedagogical. At the preliminary stage, the teenager is assigned a “silence mode” – it is forbidden to speak aloud for several days.

Psychocorrection

The goal of rational psychotherapy is to form an adequate attitude, to accept a new low timbre. The work is carried out in the form of explanatory conversations, includes listening to samples of male voices, autogenic training. At this stage, it is important to achieve conscious participation of the adolescent in the process of voice production.

Therapeutic and breathing exercises

In parallel with psychocorrection, physiotherapy exercises are prescribed . This direction allows you to harmonize the nervous system, develop correct kinesthesia, relieve muscle tension from the larynx and organs of articulation. Breathing exercises help to normalize physiological respiration, rationally use the air stream during phonation. Mutational Dysphonia symptoms classification

Speech therapy correction

With mutational dysphonia, a course of phonopedic exercises is conducted, aimed at developing the correct stereotype of voice formation. Articulatory gymnastics and voice exercises are performed under the supervision of a phonopedist . Useful manual and vibration massage of the face and neck, self-massage.

After completing the preparatory exercises, the speech therapist invites the teenager to reproduce several samples of the “adult” voice. By the selection method, they stop at the tone, during the reproduction of which there is no subjective discomfort. The new sound is consolidated in the process of voice training. In order to increase self-control, biofeedback therapy is used . The duration of the full course of dysphonia correction is on average 1 month.