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Objective: Nonsurgical and surgical options are available for transgender vocal feminization. This systematic review explores the efficacy of feminizing voice therapy and phonosurgery. Methods: A systematic review was performed using PubMed, Cinahl Plus, Ovid SP, Web of Science, Science Direct, and Google Scholar with terms related to transgender phonosurgery and voice therapy. Included studies were outcomes-based vocal feminization interventions for transgender women. Data were collected on pre- and postintervention fundamental frequency (F0), externally measured vocal femininity, patient satisfaction, and complications. Results: Two hundred twelve studies were identified and 20 met inclusion criteria. Postintervention patient satisfaction was approximately 80% to 85% for voice therapy, endoscopic shortening, and cricothyroid approximation. Complications were reported for each phonosurgery technique, most commonly decreased mean phonation time and loudness. Of the 20 studies, 17 were used for meta-analysis of F0 change. F0 increased by 31 Hz with voice therapy alone, 26 Hz with laser reduction glottoplasty, 39 Hz with cricothyroid approximation, and 72 Hz with endoscopic shortening. Conclusion: The literature supports both voice therapy and phonosurgery, depending on a patient's magnitude of desired pitch change and tolerance for cost and potential complications. Most will likely benefit from voice therapy, as it is highly satisfactory, raises vocal pitch, and is noninvasive. However, endoscopic shortening is also highly satisfactory and provides the greatest absolute increase in vocal pitch. If surgery is chosen, postoperative voice therapy may additionally increase F0, stabilize the voice, and create a more female timbre. However, further studies will be necessary to provide definitive clinical recommendations.

\s=b\A protocol is presented that was designed to provide comparative data on the two primary oral cavity functions affected by surgery: speech and swallowing. Three types of reconstruction (skin grafts, hemitongue flaps, and myocutaneous flaps) and results of a series of tests given to 15 surgical patients with T2 and T3 tongue and/or floor of mouth lesions were evaluated. The patients who had split-thickness skin grafts had the best oral function results. The study suggests that tongue mobility is the most significant variable in determining postoperative speech results. (Arch Otolaryngol Head Neck Surg 1987;113:496-500) The major objective of oral cavity reconstruction is the restoration of preoperative speech and degluti¬ tion. While there are numerous arti¬ cles reporting different methods of oral cavity reconstruction, there are few that present comparative data on the effects that different reconstruc¬ tive approaches have on oral cavity function. LaFerriere et al1 reported postoperative speech and deglutition results in their analysis of skin graft application in composite resections.Logemann and BytelP provided objec¬ tive evaluation of three methods of tongue closure in oral cavity recon¬ structions. Before a meaningful reha¬ bilitative assessment of different reconstructive methods can be made, the affected functions, speech and swallowing, must be measured in a meaningful manner to allow for com¬ parison of results.In the past, the head and neck sur¬ geon's prime concern in reconstruc¬ tion of the oral cavity after ablative surgery has been to close the wound with the least amount of morbidity. Wound closure, in many instances, took priority over functional consider¬ ations. This was partially due to the limited number of reconstructive options available. Currently, however, a number of alternatives are available to reconstruct an oral cavity defect in a single stage, ie, skin graft, tongue flap, local flap, regional flap, myocu¬ taneous flap, or free flap. But without any meaningful objective data on how the methods affect function, the deci¬ sion is based on the surgeon's prefer¬ ence. To date, no clinical protocol has been devised to provide comparative functional data.The purpose of this study was to determine if meaningful, comparative data could be obtained from testing postoperative speech and swallowing in patients who were treated for oral cavity cancer. The speech parameters measured included intelligibility, tongue mobility, diadochokinetic rate, and articulation. An index of oral deglutition called the chew/swallow index was also assessed. PATIENTS AND METHODSThe charts of 212 patients with oral cavity cancer who were treated between Jan 1, 1976, and Dec 31, 1981, at Emory University, Atlanta, and associated hospi¬ tals (Veterans Administration Medical Center, Grady Memorial Hospital, and Crawford-Long Hospital, Atlanta) were reviewed. Patients who had T2-T3 oral tongue lesions and/or floor of mouth lesions were selected (Table 1). A limited number of patients who had undergone a later...

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The World Professional Association for Transgender Health is an international organization that has a purpose of providing guidelines for safe, effective, and evidence-based practice for the Transgender/Transsexual client throughout the world in all aspects of care, including medical, psychological, voice, speech, and other services. Newly formed and accepted as an integral part of the organization, the Voice and Communication Committee is comprised of four speech-language pathologists (SLPs) from the United States, Canada, the United Kingdom, and Australia. This article introduces SLPs to this committee and its important work in providing guidelines for offering voice and communication therapy to all Transgender (TG) clients.