Author: Roselyn Mathew, Reg. CASLPO, Speech-Language Pathologist
Date: Wednesday, October 09, 2024

1. Introduction 

2. How do we change pitch?

3. What are pitch related voice disorders? 

4. Common pitch related disorders

   • Puberphonia

   • Androphonia

   • Diplophonia

5. Conclusion 

Pitch is a component of voice that determines how high or low it sounds. It is an important feature that determines a voice. Generally, a feminine voice has a higher pitch and a masculine voice has a lower pitch. The pitch of a voice is determined by a number of factors which are: the size of the vocal folds, the size of the larynx, the muscles of the larynx and the number of times vocal folds vibrate while producing voice. Higher pitch is due to smaller size of larynx, smaller vocal folds, tensed muscles of the larynx and higher number of vibrations of the vocal folds.   Lower pitch is due to larger larynx, bigger vocal fold size, relaxed muscles of the larynx and lesser number of vibrations of the vocal folds. Everyone can make different types of pitches to a certain degree which is called pitch range. The pitch range of a person is the number of pitches a person can make from their comfortable lowest pitch to their highest comfortable pitch. The pitch range is not constant and varies from one person to another.  Although we do not completely use our pitch range for general speaking, we have variations in pitch when we speak. This is called intonation or change in the tone of voice.

Change in pitch happens due to certain changes in the larynx, muscles in the larynx and vocal folds. These are:

• Vocal folds become thinner and stretch for higher pitch sounds. They also vibrate a greater number of times for higher pitch. Vocal folds become thicker and relax for lower pitch. The number of vibrations is also lesser for lower pitches. 

•  The stretching and relaxing of vocal folds are also determined by certain cartilages and muscles in the larynx. Their movements also play a role in changing the stretching and relaxation of the vocal folds.

Pitch related voice disorders are a type of voice disorders where the change in pitch is prominently heard in the voice. The pitch gets shifted to a higher or lower pitch which means the voice of the person sounds higher or lower than usual. Pitch related voice disorders may or may not have other voice issues but the most noticeable change in voice would be the change in pitch. 

These can have a huge impact on a person’s life, physically, mentally as well as socially. A person with a pitch related voice disorder even though they can speak loud and clear would hesitate to talk due to the fear of being ridiculed by others. It also largely affects their communication and confidence.

PUBERPHONIA

Puberphonia is a pitch related voice disorder where a person continues to use a higher pitch after puberty. It is most commonly noticed in people who are assigned male at birth. Generally, certain structural and physiological changes happen in the larynx or voice box during puberty, which results in lowering of pitch in both males and females. Usually, the voice of individuals who are assigned male at birth goes deeper by 1 octave and the voice of individuals assigned female at birth deepens by around 3-5 semitones. A person with Puberphonia would not have a deepening of voice. The higher pitched voice might also sound weak and breathy with pitch breaks. 

Causes

The cause of Puberphonia can be biological or psychological.

Biological causes are:

• Lack of adequate structural and physiological changes in the larynx during puberty

  • Certain structural and physiological changes happen in larynx during puberty. These changes result in a shift in voice. When there are no changes happening, the voice would continue to be the same as before. 

• Slow structural and physiological development which is not complete after puberty

  • In this case, structural and physiological changes happen, but the rate of changes happening is slow. Due to this, there won’t be any significant changes in the voice.

• Vocal folds not being in their natural position and being in a falsetto position

  • The position of vocal folds changes while vibrating at different pitches. When the vocal folds do not change their position and is only at the falsetto position, the resulting voice would sound only high pitched without going to lower pitch ranges. 

• Increased muscle tension in the larynx resulting in the larynx being at a higher position

  • When larynx is raised, some amount of laryngeal tension happens which stretches the vocal folds, resulting in a higher voice. 

• Muscle incoordination

  • The change in pitch is a finely tuned process and there needs to be proper muscle coordination in order for the voice change to different pitches.

• Congenital anomalies in the larynx

  • Certain structural changes in larynx might not result in proper laryngeal movement or muscle coordination. The development of structure of the larynx might also be affected resulting in a lack of pitch change. 

Psychological cause

• Mental resistance to change in voice during puberty and lack of willingness to adapt to voice changes

  • When someone is not ready to accept the change in their voice, they might not accept the natural process of voice change and would continue to use the higher pitched voice. 

• Emotional stress

  • When someone gets overly conscious of voice breaks, especially at an earlier stage, they might feel stressed and might continue to use the ‘old’ voice that they are comfortable with.

Treatment

• Voice therapy

  • A speech language pathologist can help in the treatment of puberphonia, if there are no significant structural changes.

• Surgery

  • Surgery would be required in cases, where anatomical changes are causing the higher pitch in voice. 

It is important to consult an ENT specialist in order to get the larynx examined first in order to get a better understanding of the cause of the issue. 

ANDROPHONIA

Androphonia is a pitch disorder where individuals assigned female at birth have a lower pitch resulting in a deeper voice similar to a male voice. There may or may not be hoarseness of voice associated with Androphonia. 

Cause

• Structural changes

  • There could be certain changes or abnormalities in the larynx that could prevent the stretching of vocal folds resulting in a deeper voice. 

• Hormonal imbalances

  • Excessive production of male hormones or androgens or limited production of female hormones such as Estrogen and Progesterone could cause the vocal folds to become larger and more relaxed, resulting in the production of a deeper voice. 

Treatment

• Hormonal therapy

  • Reducing the production of male hormones or increasing the production of female hormones helps in changing the voice to a higher pitch.  A test is initially done to see the amount of hormone production. 

• Surgery

  • Surgery is performed to correct structural abnormalities, if any.

• Voice therapy

  • A speech language pathologist can work on keeping the pitch at the higher end of the vocal range and can also work on alternative methods to help keep the voice at a higher range. 

DIPLOPHONIA

Diplophonia is a pitch related voice disorder where a person speaks with 2 pitches simultaneously. It is also known as Diphthong.  Vocal folds are muscular structures that produce voice by vibration. Double pitches occur due to faulty movements of the vocal folds. Diplophonia may or may not be accompanied with voice hoarseness, breathiness and reduced volume.

Causes

In many cases, Diplophonia does not occur by itself but is mainly associated with other voice problems. There might be harshness, hoarseness, breathiness, voice instability or reduced volume along with Diplophonia. There are different causes for Diplophonia which are:

• Injury to the larynx

  • An injury to the larynx could result in a muscle or nerve damage which could result in a faulty or abnormal movement of the vocal folds.

• Laryngitis

  • It means inflammation of the larynx. When this happens the movement of the vocal folds might get disrupted which could result in Diplophonia.

• Vocal nodules, cysts or polyps

  • They are different types of growth on the vocal folds. These growth on the vocal folds affects their vibration patterns which could result in Diplophonia.

• Unilateral vocal fold paralysis

  • It means one vocal fold is paralyzed. This could cause 2 pitches due to the abnormal vocal fold movements.

Treatment

The treatment of Diplophonia is dependent on the type of issue associated with it. Some treatment methods are:

• Voice therapy

  • It is particularly done when diplophonia is caused due to a functional disorder

• Surgery

  • It is done for correcting any structural abnormalities

• Medications

  • Medications may be given for certain situations, for example medications would be helpful to reduce inflammation of the larynx in Laryngitis. 

Pitch is an important component of voice and determines how high or low a voice sounds. Pitch related voice disorders are voice issues where the pitch is different than the average pitch. There are different causes for this which could be physiological, structural or psychological. Most of the time, these can be treated by a professional. It is important to undergo an assessment first to understand the main cause of the problem and then proceed with an appropriate treatment plan.

To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.