Mutational Falsetto Research Articles

How Persistent Should We Be in Voice Therapy in Mutational Falsetto Patients?

How Persistent Should We Be in Voice Therapy in Mutational Falsetto Patients?

Efficacy of voice therapy in the treatment of mutational falsetto

Objectives: This study aimed to evaluate the effectiveness of voice therapy in patients with mutational falsetto with objective and subjective methods. Patients and Methods: In this retrospective study, 18 male patients (mean age: 17.2±3.7 years; range, 14 to 26 years) diagnosed with mutational falsetto underwent acoustical analysis between May 2020 and January 2023 using Praat software. For objective acoustic analyses, fundamental frequency, jitter, shimmer, and maximum phonation time parameters were used. For subjective analyses, the GRBAS (Grade, Roughness, Breathiness, Asthenia and Strain) scale and the voice handicap index were used. Pre- and post-voice therapy subjective and objective parameters were compared. Results: The mean pre-voice therapy fundamental frequency value of the patients was 183.63±22.18 Hz, while the post-therapy value was 125.03±15.52 Hz. The mean pre-voice therapy voice handicap index score of the patients was 30.33±3.67, whereas the post-therapy score was 9.77±2.48. While the GRBAS scale value of the patients was 7.38±1.24, post therapy score was 1.55±1.29. As a result of the comparison of the objective and subjective values before and after the therapy, a statistically significant difference was found (p<0.001). Conclusion: Mutational falsetto can be treated with the use of inexpensive sound analysis programs that do not require special hardware in clinical practice and with sound therapy methods.

Presbylarynx, Functional Voice Disorders, Muscle Tension Dysphonia

Presbylarynx refers to age-related structural changes of the vocal folds that include muscle atrophy, reduced neuromuscular control, loss of superficial lamina propria layer, and reduced pliability. The changes result in thin and bowed vocal folds, increased vocal effort requirements, breathy voice, change in habitual pitch, and strain. The primary treatment options are voice therapy focused on strengthening breath support and the intrinsic muscles of the larynx, and optimization of resonance; injection augmentation of the vocal folds; and type I thyroplasty. Functional dysphonia is defined as change in voice quality in the absence of structural or neurological abnormalities of the larynx. Muscle tension dysphonia (MTD) is a subtype of functional voice disorders and involves laryngeal muscle tension imbalance due to excessive or dysregulated activation resulting often in strained or breathy voice. MTD can be divided into primary (psychological etiology or vocal misuse) and secondary (compensatory for organic laryngeal pathology). The mainstay of treatment for MTD is voice therapy, along with medical or surgical treatment of the underlying vocal pathology in secondary MTD. Mutational falsetto, or puberphonia, is a functional voice disorder where a high-pitched, pre-adolescent voice fails to transition to the lower pitch of adulthood. This review contains 5 figures, 7 tables, 4 videos and 10 references Key Words: Presbylarynx, Injection augmentation, Type I thyroplasty, Primary muscle tension dysphonia, Secondary muscle tension dysphonia, Muscle tension patterns, Manual circumlaryngeal therapy, Functional dysphonia, Mutational falsetto

Efficacy of Kinesio taping on Mutational Falsetto: A Double Blind, Randomized, Sham-controlled Trial

ObjectivesThis study aimed to assess the efficacy of Kinesio taping on male patients with mutational falsetto undergoing voice therapy. DesignDouble blind, randomized, sham-controlled clinical trial. ParticipantsInterviews were conducted with thirty seven mutational falsetto patients. Included 32 participants were randomized and divided into two groups. Two were dropped out due to irregular attendance, 30 participants were included in final analysis. InterventionsThe study group was treated with voice therapy and applications of three different therapeutic Kinesio taping techniques with seven Kinesio tapes four times over two weeks, and the control group was treated with voice therapy, and applied to sham Kinesio taping. Outcome measuresThe values of fundamental frequency, jitter, shimmer, noise-harmonic ratio, maximum phonation time, Voice Handicap Index-10 scores, and Grade–Roughness–Breathiness–Asthenia–Strain Scale scores were recorded at the baseline and after the two weeks. ResultsThere were significant differences between the study group and the control group with respect to the values of fundamental frequency (P = 0.011), jitter (P = 0.041), shimmer (P = 0.036), noise-harmonic ratio (P = 0.003), maximum phonation time (P ≤ 0.001), Voice Handicap Index-10 scores (P = 0.036), and Grade–Roughness–Breathiness–Asthenia–Strain Scale scores (P = 0.007; P ≤ 0.021; P = 0.022; P = 0.002; P = 0.021, respectively) at the end of the study. ConclusionsThe study demonstrated that Kinesio taping with voice therapy is an efficient and effective technique for treating mutational falsetto patients.

Acoustic parameters for the evaluation of voice quality in patients with voice disorders.

To investigate the value of the standard deviation of the fundamental frequency (F0 SD), jitter, and shimmer for the evaluation of voice quality and the description of vocal characteristics in patients with voice disorders. This prospective cohort study included 4 groups: vocal cord polyps (VCP) group (n=55), early-stage (stage I-II) laryngeal carcinoma (ELC) group (n=35), mutational falsetto (MF) group (n=17), and a normal control group (n=29). The participants were asked to emit a sustained vowel /a/ and raise the pitch gradually. Acoustic parameters, including F0, F0 SD, jitter, and shimmer, were recorded and analyzed. The F0 SD was highest in the MF group. The F0 SD in the MF group and the ELC group was significantly higher than that in the VCP group and the control group (P<0.05), and the F0 SD in the VCP group was significantly higher than that in the control group (P<0.05). However, there was no significant difference in F0 SD between the MF group and the ELC group (P>0.05). The jitter and shimmer in the ELC group were significantly higher compared to the other groups (P<0.05), and the jitter and shimmer in the VCP group were significantly higher than those in the MF group and the control group (P<0.05). There were no significant differences in jitter or shimmer between the MF group and the control group (P>0.05). F0 SD, jitter, and shimmer are important parameters for the evaluation of pitch variation during sustained phonations, and can discriminate between MF and voice disorders.

Puberphonia: From classic to modern approach

&amp;lt;p&amp;gt;Voice is a significant component of communication that allows us to express information and emotions, so it is the foundation of verbal communication. Maturation of the body involves dilation of the larynx and lower positioning of the larynx in the neck, resulting in multiple changes in voice quality. The rapid changes in the human larynx during puberty are more evident in males. Such changes can result in voice mutation - puberphonia. Puberphonia, also called mutational dysphonia or mutational falsetto, is the failure of a natural decrease in fundamental frequency or pitch. We can also defined puberphonia as persistent adolescent voice even after puberty in the absence of organic cause. This functional voice disorder can have multiple consequences on the personality and quality of life of an individual that often encounters problems that include psychological, emotional, social, and professional difficulties. This article aims to review the relevant and accessible literature on puberphonia in a comprehensive concise manner, highlighting the etiology, prevalence, clinical manifestation, consequences on quality of life, as well as evolution of the approach and attitude to its treatment.&amp;lt;/p&amp;gt;

Efficacy of Low Mandible Maneuver on Mutational Falsetto

Objectives: Mutational falsetto (MF) is a functional voice disorder involving failure to transition from the high-pitched voice of childhood to the lower-pitched voice of adolescence and adulthood. The low mandible maneuver (LMM) is used by professional singers to relax the larynx and expand the resonance space. It relaxes suprahyoid muscles and pushes the larynx backwards, so it can be used as a therapy for MF. Material and Methods: The data of 20 MF patients treated by the LMM were analyzed in this study. All of the patients were asked to complete the Voice Handicap Index-10 (VHI-10) before the first session, and again 2 weeks after the second visit. The Grade-Roughness-Breathiness-Asthenia-Strain (GRBAS) scale scores and fundamental frequency (F0) were analyzed for each patient. Results: All except 1 patient reported that they completed the exercises without difficulty; the patient who did not perform the exercises cited reasons other than their difficulty. Only 2 patients failed to transition from MF to a lower-pitched voice. The GRBAS scale scores (all parameters) differed significantly between the first and second sessions. The VHI-10 score also changed, i.e., self-perceived voice quality was improved significantly, as was the F0. Conclusions: Our results showed that the LMM is an efficient and rapid technique for treating MF patients and shows high patient compliance.

G protein coupled oestrogen receptor 1, aromatase, 17β-HSD and cAMP level in mutational falsetto.

Puberphonia or mutational falsetto (MF) is seen more in males, and hormonal changes are considered to be among the aetiological causes. Therefore, the aim of this study was to investigate the molecules [G protein-coupled oestrogen receptor 1 (GPER-1), aromatase, 17-beta-hydroxysteroid dehydrogenase (17β-HSD), cyclic adenosine monophosphate (cAMP) levels] related to receptors and pathways in patients with MF. The study included 30 MF patients and a control group of 30 healthy individuals. Voice recordings were made of the MF patients and acoustic analyses were applied. The serum GPER-1, aromatase, 17β-HSD, cAMP levels and TSH, estradiol, prolactin, progesterone, and testosterone levels were evaluated in venous blood samples. In the MF patients, the GPER-1 level determined of mean 3.68 (1.95-4.26) pg/ml, 17 beta dehydrogenase of 5.25 (2.73-6.77) ng/ml, and cAMP of 24.62 (11.62-30.35) ng/ml were statistically signficantly higher than those of the control group (p = 0.008, p = 0.002, p = 0.003, respectively). The aromatase level in the MF patients was found to be 3.48 (2.01-4.91) and the difference between the two groups was not statistically significant (p = 0.067). The GPER-1, 17β-HSD, and cAMP levels were found to be higher in the MF patients than in the control group, suggesting that they could be of importance in the diagnosis and treatment of MF.

Efficacy of Doctorvox Voice Therapy Technique for Mutational Falsetto

This study investigated the efficiency of the DoctorVox Voice Therapy Technique using high back-pressure on mutational falsetto. A total of 21 men with mutational falsetto and 25 age-matched healthy men were included. All patients received DoctorVox voice therapy using the doctorVOX device with high back-pressure. Ear nose and throat examination, videolaryngostroboscopy, and acoustic (SPL, mean F0, first three formants, jitter%, shimmer%, and NHR) and electroglottographic analysis (Closed Quotient and Contact Index) were performed at pretreatment, and at 1 and 6 months after treatment. The VHI-10 and the GRBAS scales were used for perceptual voice evaluation. Compared with the pretreatment values, the first and sixth month values after treatment demonstrated a significant decrease inVHI-10, GRBAS, F0, F1, F2, F3, Jitt %, Shimm %, NHR, and contact index and a significant increase in closed quotient among MF patients. In the sixth month after treatment, VHI-10, jitt%, and NHR parameters were significantly lower than those of the first month. The first-month data for VHI-10, jitt%, and NHR values was significantly higher than that of the control group, while there was no significant difference between the sixth-month data and that of the control group. The DoctorVox Voice Therapy Technique is highly effective in mutational falsetto treatment. At the first session, the patients reach a lower fundamental frequency in the chest register; by the 1 month after treatment, they have a normal pitch at speaking. The improvement in perturbation measures may continue for 6 months. Patients should be followed up regularly for at least 6 months after treatment to obtain optimum treatment outcomes.

Comparison of Two Multiparameter Acoustic Indices of Dysphonia Severity: The Acoustic Voice Quality Index and Cepstral Spectral Index of Dysphonia

The Acoustic Voice Quality Index (AVQI) and the Cepstral Spectral Index of Dysphonia (CSID) are two multiparameter acoustic indices designed to objectively estimate dysphonia severity and track treatment outcomes. This study compared the performance of these two indices using a common corpus of dysphonic speakers. Pre- and posttreatment samples of sustained vowel and connected speech were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis (n = 20), adductor spasmodic dysphonia (n = 20), primary muscle tension dysphonia (n = 20), benign vocal fold lesions (n = 20), presbylaryngis (n = 20), and mutational falsetto (n = 12). Listener ratings of dysphonia severity were compared to acoustic estimates of severity derived from two iterations of the AVQI (versions 2.02 and 3.01) as well as the CSID. The AVQI- and CSID-estimated severity for sustained vowels, connected speech, and a combined context were strongly correlated and significantly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. However, multiple regression analysis (adjusted for age, sex, and diagnostic category) revealed that the CSID generally accounted for more variance in listener-perceived severity ratings, and the contribution of the AVQI was small and statistically insignificant when the CSID was already in a combined model. The AVQI and the CSID were strongly correlated and both provided valid estimates of dysphonia severity. However, associations observed between the CSID- and listener-estimated dysphonia were almost uniformly stronger than either version of the AVQI, suggesting that the CSID outperformed the AVQI.

Voice Therapy Effect on Mutational Falsetto Patients: A Vocal Aerodynamic Study

The study aims to evaluate the effectiveness of voice therapy (VT) and analyze the vocal aerodynamic characteristics in mutational falsetto (MF) patients. From October 2010 through May 2014, 26 patients with MF at Sun Yat-sen Memorial Hospital were studied retrospectively. Vocal assessment, including the 10-item Voice Handicap Index (VHI-10), fundamental frequency (F0), and vocal aerodynamic parameters (subglottic pressure [SGP]), aerodynamic power [AP], mean expiratory airflow, and maximum phonation time [MPT]), was proceeded before and after VT. Before VT, the mean F0, AP, and SGP of MF patients were significantly higher than Control Group, whereas mean MPT was significantly shorter. After a 4-week VT, the mean F0, AP, and SGP were decreased, and the mean MPT was significantly increased compared with the measurements obtained before VT. After the 4-week VT, the VHI-10 scores in 21 patients reverted to normal Control Group's level (Effective Subgroup), whereas the VHI-10 scores in the other 5 patients remained higher than the normal Control Group (Ineffective Subgroup). Subgroup analysis showed the mean AP and SGP of the Ineffective Subgroup were similar to the Control Group, whereas the Effective Subgroup showed higher AP and SGP. After the 4-week VT, MPT in both the Effective Subgroup and Ineffective Subgroup increased significantly, but AP and SGP in the Ineffective Subgroup did not change significantly. VT is an effective treatment for MF patients with laryngeal hyperfunction. Most MF patients can return to normal voice in 4 weeks. Vocal aerodynamic examination can help in predicting the VT effect and deciding the treatment plan. MF patients without laryngeal hyperfunction may need longer VT period or other adjuvant treatment.

Manual laryngeal reposturing as a primary approach for mutational falsetto.

Mutational falsetto is a functional voice disorder characterized by failure of the male high-pitched preadolescent voice to transition to the lower pitch of adolescence and adulthood. Few objective outcomes data exist regarding the effectiveness of voice therapy for this poorly understood disorder. This study examined the immediate effects of a single therapy session using manual laryngeal reposturing as a primary approach in the management of mutational falsetto. Retrospective case series, pre-/posttreatment. Manual circumlaryngeal techniques, including digital laryngeal reposturing maneuvers, were used as the primary approach to treat 12 consecutive males with mutational falsetto (mean age 17.5 yrs., range 14-25 years). Pre- and posttreatment audiorecordings of connected speech and sustained vowel samples were submitted to auditory-perceptual and acoustic analysis to assess the effects of a single voice therapy session. Acoustic estimates of severity in both connected speech and sustained vowel productions were computed using the Cepstral Spectral Index of Dysphonia (CSID), a multivariate dysphonia summary tool that incorporates cepstral and spectral measures. Pre- and posttreatment comparisons confirmed a significant change in the direction of normal vocal function within a single treatment session for both listener- and CSID-based estimates of dysphonia severity. Behavioral therapy using manual laryngeal reposturing by an experienced voice clinician is an effective and efficient primary approach for mutational falsetto. 4. Laryngoscope, 127:645-650, 2017.

Speech Range Profile (SRP) Findings Before and After Mutational Falsetto (Puberphonia)

Mutational falsetto is a temporary adolescent voice. Voice therapy support in mutational falsetto helps the individual to regain a healthy voice. Speech Range Profile (SRP) is considered to be a method requiring less time in the pretherapy and posttherapy evaluations of voice patients. The purpose of this study was to determine the differences between the SRP results of male subjects experiencing mutational falsetto before and after therapy. Sixteen male participants have been included in this study. F0, MinF0, MaxF0, F0Range, F0Range (st), MindB SPL, and MaxdB SPL have been taken to evaluation. SRP recordings of all subjects have been performed. All the recordings have been repeated before and after therapy. A statistically significant difference has been observed between the F0 and MinF0 values before and after therapy (P<0.001). SRP provides important information about frequency and intensity. In mutational falsetto, SRP is a useful technique in terms of evaluating success in therapy.

Bilateral In-Office Injection Laryngoplasty as an Adjunctive Treatment for Recalcitrant Puberphonia: A Case Report and Review of the Literature

Puberphonia or mutational falsetto is a voice disorder seen in male adolescents. It is defined as the failure of the voice to change from the high pitch of early childhood to the low pitch of adulthood. Puberphonia is usually treated with voice therapy (with or without adjunctive laryngeal manipulation) and psychological counseling. Small series of surgical treatments have also been described. We present the first report of bilateral in-office injection laryngoplasty with hyaluronic acid with voice therapy to treat a 22-year-old male with puberphonia that had not responded to voice therapy. The subject presented with a speaking fundamental frequency of 152Hz, which decreased to 102Hz immediately after bilateral injection laryngoplasty and has been maintained at 108Hz after 24months.

Role of Voice Therapy in Patients with Mutational Falsetto

ABSTRACT Background Mutational falsetto is the most common mutational voice disorder, found in all ages. Clinicians often miss this diagnosis due to unfamiliarity with the condition. The voice of a person with mutational falsetto is high pitched, weak, thin, breathy, hoarse and monopitched. Objective This study was carried out to evaluate the efficacy of voice therapy in persons with mutational falsetto. Methods Eleven male patients with ages between 18 and 26 years (mean age 22.18 years, SD 2.52) diagnosed with mutational falsetto underwent acoustical analysis using Praat Software, perceptual analysis using grade, roughness, breathiness, asthenia and strain (GRBAS) scale and psychosocial analysis using emotional component of voice handicap index (VHI). All the components were analyzed pre- and postvoice therapy. Results Improvement in acoustic analysis parameters was statistically significant with p-value less than 0.0001(pretherapy mean of fundamental frequency (F0) was 217.45 with SD 8.68, whereas post-therapy mean of F0 was 127.50 with SD 5.32). Significant improvement in perceptual analysis was seen post-therapy on GRBAS scale. Improvement in psychosocial aspect was also statistically significant with p-value less than 0.0001 (pre-therapy mean 26.18, SD 1.72 post-therapy mean 7, SD 1.15). Conclusion Voice therapy plays an important role in lowering F0 and alleviation mental agony of the patients with mutational falsetto. How to cite this article Varma A, Agrahari AK, Kumar R, Kumar V. Role of Voice Therapy in Patients with Mutational Falsetto. Int J Phonosurg Laryngol 2015;5(1):25-27

Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension.

To evaluate type IIIB thyroplasty using the excised larynx bench apparatus and determine how altering vocal fold contour by performing bilateral medialization of the inferior vocal fold affects phonation. This procedure could be performed in patients for whom pitch lowering is desirable, such as female-to-male transsexuals or male patients with mutational falsetto in whom intensive voice therapy was insufficient. Aerodynamic, acoustic, and high-speed videokymographic data were collected for nine larynges at three subglottal pressure inputs for each of three conditions: normal; type IIIB thyroplasty; and combined type IIIB with modified bilateral type I thyroplasty intended to create a more rectangular glottal configuration. Each larynx served as its own control. Phonation threshold flow (p=0.005), phonation threshold power (p=0.031), and airflow varied across conditions with highest values for type IIIB thyroplasty and lowest for the combined procedure. Fundamental frequency was significantly different (p<0.001), decreasing by approximately 100Hz from control to type IIIB trials, and then by approximately 15Hz from IIIB to combined procedure trials. Vibratory amplitudes and intrafold phase difference were highest for type IIIB trials. Addition of bilateral inferior medialization to type IIIB thyroplasty provided some further decrease in frequency, but mostly served to increase tension, reduce airflow, and produce a vibratory pattern which more closely mirrored control trials. Exploration of this combined procedure in patients may be warranted if not completely satisfied with the results from type IIIB thyroplasty alone.

Toward Validation of the Cepstral Spectral Index of Dysphonia (CSID) as an Objective Treatment Outcomes Measure

To examine the validity of the Cepstral Spectral Index of Dysphonia (CSID) as an objective treatment outcomes measure of dysphonia severity. Pre- and posttreatment samples of sustained vowel and connected speech productions were elicited from 112 patients across six diagnostic categories: unilateral vocal fold paralysis, adductor spasmodic dysphonia, primary muscle tension dysphonia, benign vocal fold lesions, presbylaryngis, and mutational falsetto. Listener ratings of severity in connected speech were compared with a three-factor CSID model consisting of the cepstral peak prominence (CPP), the low-to-high spectral energy ratio, and its standard deviation. Two additional variables, the CPP standard deviation and gender, were included in the five-factor CSID model to estimate severity of vowels. CSID-estimated severity for sustained vowels and connected speech was strongly associated with listener ratings pretreatment, posttreatment, and change observed pre- to posttreatment. Spectrum effects were examined, and severity of dysphonia did not influence the relationship between listener perceived severity and CSID-estimated severity. The results confirm a robust relationship between listener perceived and CSID-derived dysphonia severity estimates in sustained vowels and connected speech across diverse diagnoses and severity levels and support the clinical utility of the CSID as an objective treatment outcomes measure.

Análises perceptivo-auditiva e acústica da voz nos momentos pré e pós fonoterapia de pacientes com falsete mutacional

A disfonia da muda vocal mais comum é o falsete mutacional. Foram analisadas de forma perceptivo-auditiva e acústica as vozes de quatro jovens do gênero masculino com falsete mutacional nas situações pré e pós fonoterapia para apresentar o resultado da intervenção fonoaudiológica. Para coleta dos dados foi solicitado que os pacientes falassem os dias da semana. Quatro fonoaudiólogas avaliaram auditivamente tais emissões por meio dos parâmetros perceptivo-auditivos: grau geral da disfonia, rugosidade, soprosidade, tensão, instabilidade e pitch. As emissões de cada paciente correspondentes aos momentos pré e pós fonoterapia foram apresentadas aos avaliadores aleatoriamente, e os avaliadores não tinham conhecimento prévio da condição da voz analisada (pré ou pós tratamento). A avaliação foi realizada por comparação e os avaliadores deveriam informar se a segunda emissão era melhor, pior ou sem modificação em relação à primeira. Quando houve modificação, deveriam selecionar três parâmetros perceptivo-auditivos referentes à mudança expressiva. Foi informado aos avaliadores somente a idade e o gênero dos pacientes. A frequência fundamental média, assim como a máxima e a mínima foram extraídas de cada emissão dos pacientes utilizando-se o Programa Praat (versão 5132). Foram extraídos e analisados, ainda, os valores de semitom. Os dados foram analisados estatisticamente. Na condição pós fonoterapia os avaliadores consideraram que houve melhora na qualidade vocal de todos os pacientes e foi observada diminuição dos valores da frequência fundamental média, mínima e máxima e nos semitons resultando em um padrão vocal mais grave e estável.

Laringoplastia de relajación o tiroplastia de tipo III

La tiroplastia de relajación está indicada en pacientes con alteraciones de la muda vocal (cambio de voz en la pubertad) resistentes al tratamiento con fonoterapia. El acortamiento de los pliegues vocales tiene como objetivo reducir la frecuencia de vibración, con lo cual el tono adquiere un carácter masculino.Presentamos el caso de un paciente masculino con puberfonía que alteraba su calidad de vida. Se revisan la técnica quirúrgica y los resultados.

Relaxation Thyroplasty for Mutational Falsetto Treatment

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty was proposed by Isshiki to shorten the vocal folds and release tension by incising and depressing the anterior segment of the thyroid cartilage. This procedure is called relaxation thyroplasty by a medial approach (anterior commissure retrusion) in the European Laryngological Society classification system. It results in a lowering of the vocal pitch. The surgery can be performed under local or general anesthesia. It should only be considered for cases not improved by speech therapy and psychological counseling. Our series included 7 male patients with a mean age of 21 years who underwent modified relaxation thyroplasty after failure of behavioral management. The assessment of outcomes was based on changes in the fundamental frequency of the voice and the Voice Handicap Index. The mean fundamental frequency was lowered from 187 Hz to 104 Hz (p < 0.001), and the mean Voice Handicap Index was improved from 70 to 21. There were no postoperative complications. The voice results were consistent over a mean follow-up of 17 months. Modified relaxation Isshiki (type III) thyroplasty is a successful treatment option for lowering vocal pitch in cases of mutational falsetto voice recalcitrant to conservative therapy.