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To the Editor.—The change of voice (mutation) takes place in male adolescence during puberty. Under the hormonal stimulus of the sex glands the growth of the larynx is accelerated, the vocal cords lengthen, and the voice level drops by about an octave. If such change of the voice does not occur, the rather rare possibility of hormonal deficiency has to be considered, as indicated by an infantile larynx and absence of secondary sex characteristics. In that case treatment would be in the province of the endocrinologist.
But, if at the age of 17 years, the larynx has grown with adult size vocal cords and if general physican development has changed a boy into a normal masculine adult, we can be sure that the persistence of a high voice is of purely psychological origin. The "mutational falsetto" occurs in patients who refuse at puberty—quite unconsciously—to accept