Objective:
This narrative review aimed to examine the effectiveness of various voice therapy techniques used in the management of mutational falsetto, a functional voice disorder characterized by persistence of a high-pitched voice after puberty despite normal laryngeal maturation. The review sought to synthesize available evidence on therapeutic outcomes and highlight effective, evidence-based strategies for clinical practice.
Methods / Design:
A comprehensive literature search was conducted across PubMed/MEDLINE, ScienceDirect, SCOPUS, and Google Scholar using the keywords “mutational falsetto”, “puberphonia”, “voice therapy”, and “speech therapy.” Boolean operators (AND, OR) were applied to enhance precision. Inclusion criteria comprised English-language studies that investigated the effects of voice therapy on individuals with mutational falsetto. Eleven studies met the criteria and were analyzed regarding study design, sample characteristics, therapy techniques, duration, and multidimensional voice outcomes including acoustic, auditory-perceptual, aerodynamic, and patient self-report measures.
Results:
Across the reviewed studies, both physiologic and eclectic voice therapy approaches demonstrated significant improvements in voice outcomes. Physiologic approaches, such as manual circumlaryngeal therapy and the DoctorVox technique, were associated with immediate reductions in fundamental frequency and enhancements in perceptual and acoustic parameters. Eclectic programs incorporating multiple techniques—such as vegetative phonation, glottal fry, digital manipulation, inspiratory phonation, relaxation, and counseling—produced consistent improvements across acoustic (F₀, jitter, shimmer, NHR), perceptual (GRBAS), aerodynamic, and self-report (VHI-10, V-RQOL) outcomes. Most participants achieved normalization of pitch and improved vocal stability and quality. However, existing studies are limited by small sample sizes, lack of control groups, and minimal long-term follow-up.
Conclusions:
Voice therapy represents the primary and most effective treatment for mutational falsetto, yielding measurable gains across acoustic, perceptual, aerodynamic, and psychosocial domains. Eclectic therapy approaches offer flexible and individualized intervention frameworks, while physiologic techniques such as manual therapy and DoctorVox training provide targeted improvement of phonatory control. Future controlled studies with larger samples, follow-up data, and direct comparisons of specific therapeutic techniques are recommended to identify the most effective evidence-based interventions for this population.