Voice Therapy in Mutational Falsetto: A Narrative Review

Mutational falsetto is a functional voice disorder identified by the persistence of a high-pitched voice in males after puberty. It causes mild dysphonia and a range of vocal symptoms, including high-pitched falsetto voice, low intensity, cul-de-sac nasality, and breathiness. Voice therapy is often the first intervention used to reduce these symptoms. This review aims to investigate the effectiveness of different voice therapy techniques in individuals diagnosed with mutational falsetto.

A comprehensive literature search was conducted across several electronic databases, including PubMed/MEDLINE, ScienceDirect, SCOPUS, and Google Scholar. To find relevant articles, several key terms, such as voice therapy, mutational falsetto, puberphonia, and speech therapy were used. Studies published in English that investigated the effects of various voice therapy techniques on individuals with mutational falsetto and their "abstract" and "full text" were related to mutational falsetto were included.

A total of 11 articles, which were accessible and relevant to the review's focus, were included in this review. The majority of these studies focused on the impact of an eclectic voice therapy approach, combining techniques such as yawn-sigh, glottal fry, laryngeal manipulation, inspiratory phonation, and humming, on multidimensional voice outcomes. However, one study focused on manual therapy as a physiologic voice therapy approach. Findings demonstrated the positive effects of voice therapy on multiple aspects of vocal function, with nearly all parameters of voice quality improving following the intervention (P < 0.05).

Voice therapy techniques, using various approaches, are considered the first line of intervention for improving the quality of voice production in patients with mutational falsetto. These techniques have led to significant improvements in multiple aspects of voice. However, further research is needed to determine which approach or technique is most effective. Future studies with larger sample sizes, standardized methodologies, follow-up assessments, and the use of more novel assessment methods and parameters are essential to strengthen the evidence regarding the effectiveness of voice therapy in this population.