title: [Treatment algorithm for patients with puberphonia].
abstract: OBJECTIVE
  We evaluated the results of treatment for puberphonia and aimed to develop a treatment algorithm for patients with puberphonia.
  
  
  METHODS
  Sixteen male patients (mean age 21.5 years; range 16 to 34 years) with puberphonia underwent voice therapy (3-10 sessions). Perceptual and acoustic analyses of vocal quality were performed in 12 patients. Perceptual analysis included the Voice Handicap Index (VHI) and videolaryngostroboscopy (VLS) and acoustic evaluations included F0 (fundamental frequency), jitter, shimmer, and NNE (normalized noise energy).
  
  
  RESULTS
  Following voice therapy, all scores of the VHI showed significant improvements (p=0.001). There was a significant improvement in vibratory pattern and mucosal wave of vocal cords in VLS evaluation (p=0.004 and p=0.002, respectively). Among acoustic parameters, only the mean F0 showed a significant change from 246 Hz to 134 Hz after treatment (p=0.001). Stabilization of F0 could not be achieved in two patients, one of whom underwent type III thyroplasty.
  
  
  CONCLUSIONS
  The main difficulties encountered in the treatment of puberphonia include stabilization of the attained F0 and widening the frequency range. Implementation of the treatment algorithm through a step-by-step approach provides an objective way of assessing the disease and its management.
authors.affiliation: Department of Otolaryngology, Medicine Faculty of Inönü University, Malatya, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kizilay
authors.forename: Yezdan
authors.initials: Y
authors.lastname: Firat
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D006801:Humans; D008297:Male; D011627:Puberty; D013070:Speech Therapy; D014827:Vocal Cords / Q000503:physiopathology; D014831:Voice / Q000502:physiology; D014832:Voice Disorders / Q000175:diagnosis / Q000534:rehabilitation*; D014834:Voice Training; D055815:Young Adult