Effect of Wendler glottoplasty on voice and quality of life of transgender women

Aires, Mateus Morais; Vasconcelos, Daniela de; Lucena, Jônia Alves; Gomes, Adriana de Oliveira Camargo; Moraes, Bruno Teixeira de

doi:10.1016/j.bjorl.2021.06.010

Cited by 12 publications

(16 citation statements)

References 44 publications

(65 reference statements)

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“…34 A common endoscopic procedure is the Wendler glottoplasty and its modifications, which involves shortening the vibrating portion of the vocal folds by creating an anterior web, hence increasing the comfortable pitch. [36][37][38][39][40][41] This surgical option reached its recent attraction owing to the long-term effect on vocal pitch, the relatively natural feminine voice it produces, and the low complication rate. Other scarless voice-feminization surgical options are also gaining attention, for example, laser-assisted muscle mass reduction.…”

Section: Discussionmentioning

confidence: 99%

“…Instead, other voice‐feminization surgeries by scarless endoscopic approach are gaining widespread use and popularity 34 . A common endoscopic procedure is the Wendler glottoplasty and its modifications, which involves shortening the vibrating portion of the vocal folds by creating an anterior web, hence increasing the comfortable pitch 36‐41 . This surgical option reached its recent attraction owing to the long‐term effect on vocal pitch, the relatively natural feminine voice it produces, and the low complication rate.…”

Section: Discussionmentioning

confidence: 99%

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Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort

Shoffel‐Havakuk

Cohen

Lahav

et al. 2023

Otolaryngol.--head neck surg.

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Objective. Chondrolaryngoplasty (laryngeal-prominence reduction) is a gender affirmation surgery for transgender women, or for cisgender people desiring an esthetic correction. Up until recently, chondrolaryngoplasty required a visible neck scar. The transoral endoscopic vestibular approach (TOEVA) is gaining widespread use as a scarless alternative for thyroid/parathyroid surgeries. This study aims to describe the feasibility, safety, and outcomes of TOEVAchondrolaryngoplasty, based on the first-ever performed cases.Study Design. A prospective cohort.Setting. An academic referral center.Methods. Adult patients interested in chondrolaryngoplasty underwent scarless TOEVA-chondrolaryngoplasty between 2019 and 2022, according to the described protocol. Video stroboscopy was recorded pre-and postoperatively. Surgical data, adverse events, and complications were recorded. Patients' satisfaction was measured using an outcome instrument for esthetic chondrolaryngoplasty.Results. Twelve patients (10 transgender women, a cisgender man, and a woman) were included. The mean age was 26.7 ± 6.5 years, ranging from 19 to 37. The average operative time was 3:01 ± 0:51 hours. The thyroid cartilage and laryngeal prominence were easily and safely approached and reduced, with no adverse events or major complications. All patients were discharged on postoperative day 1. A single patient had a temporary mental nerve hypoesthesia that resolved spontaneously. Otherwise, no other complications were encountered. Vocal folds' function remained unchanged in all patients. Patients were very much to completely satisfied with the surgical results as measured by the outcome instrument; median (interquartile range), 25 (21-27.75). Conclusion.In this first reported cohort of scarless TOEVAchondrolaryngoplasty, this approach was proven to be safe and feasible, with no adverse events or major complications, and with high patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort

Shoffel‐Havakuk

Cohen

Lahav

et al. 2023

Otolaryngol.--head neck surg.

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“…Altering aspects of vocal function in ways congruent with a patient's gender identity may be a critical component of a transgender individual's gender‐affirming health care. Incongruence between a transgender patient's voice and their gender identity has been associated with increased symptoms of anxiety and depression; conversely, gender‐affirming vocal treatments have been shown to significantly improve mental health, as well as the voice‐related and psychosocial quality of life outcomes in transgender patients 9,14–17 . As such, improving vocal outcomes for transgender patients has garnered increased attention in recent years.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Loss of Follow‐Up in Transgender Patients Receiving Vocal Therapy

Davis

Akst

et al. 2023

The Laryngoscope

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ObjectivesOptimal vocal care for transgender patients necessitates regular follow‐up. Factors associated with loss of follow‐up in voice patients have never been investigated. In this study, we report a case series of transgender patients seeking vocal care at our institution and compare those who were and were not lost to follow‐up.MethodsCharts of transgender patients diagnosed with gender dysphoria who sought vocal care at our institution from January 2018 through May 2022 were reviewed. A chronological timeline of each patient's care at our vocal clinic was recorded. Loss of follow‐up was defined as instances in which patients were not yet satisfied with their vocal outcomes and expressed interest in scheduling a subsequent visit but had not yet done so. Logistic regressions were performed to identify factors associated with loss of follow‐up.ResultsOf 73 patients identified, 59 (80.8%) were assigned male at birth, and 72 (98.6%) were non‐Hispanic White. Loss of follow‐up occurred in 35 (47.9%) patients. Patients who received vocal surgery were significantly less likely to be lost to follow‐up (OR: 0.16 (0.03, 0.79); p = 0.03). The availability of telemedicine options for vocal care was protective against loss of follow‐up (OR: 0.09 (0.02, 0.44); p = 0.003). Patients who received other non‐voice gender‐affirming treatments concomitant to their vocal care were more likely to be lost to follow‐up (OR: 4.44 (1.35, 14.59); p = 0.01).ConclusionLoss of follow‐up in transgender patients receiving vocal care is common. Providing telemedicine options and encouraging patients to complete vocal care prior to or after receiving other non‐voice gender‐affirming treatments may help increase rates of follow‐up.Level of Evidence4 Laryngoscope, 2023

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“…Multiple recent studies have demonstrated that anterior webbing techniques are safe and effective and they provide the most significant increase in fundamental frequency [11 ▪▪ ,20,23 ▪▪ ,29,30 ▪▪ ]. An average pitch increase of around 78 Hz can be achieved with glottoplasty (range 20 – 112 Hz) has been reported in recent meta-analyses (16 studies and 782, 14 studies and 566 patients) [11 ▪▪ ,23 ▪▪ ]; however, more recent studies with robust methodology and relatively large cohorts have shown a smaller change in F 0 of around 50 Hz [22,30 ▪▪ ,31].…”

Section: Wendler's Glottoplasty and Its Modificationsmentioning

confidence: 99%

Current approaches to gender-affirming vocal care

McBrinn,

Antoni,

Al Yaghchi

2024

Current Opinion in Otolaryngology &Amp; Head &Amp; Neck Surgery

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Purpose of review This review addresses the challenges faced by transgender women in achieving congruence between gender identity and voice characteristics and emphasises the importance of a multidisciplinary approach involving therapeutic and surgical interventions. Recent findings Recent literature on gender-affirming vocal care emphasises key themes such as assessment, voice feminisation therapy, and various surgical techniques, including glottoplasty and its modifications. Recent publications focused on outcomes, duration, and impact on vocal quality and scrutinised complications associated with surgical interventions. Summary Most publications in the last 18 months advocate for the integration of voice therapy and surgery for optimal outcomes. Utilising a combined approach is significantly more effective in terms of fundamental frequency gain compared to therapy alone. Modified Wendler's Glottoplasty remains the preferred and most reliable surgical intervention. However, surgery is not without its complications and vocal trade-offs, in particular, its impact on vocal projection and the risk of long-term dysphonia. Post-surgery rehabilitation improves long-term outcomes. Recent publications on alternative surgical approaches, namely laser reduction glottoplasty and feminisation laryngoplasty, show promise but the results are more difficult to generalise. Future direction Prospective multicentre studies with standardised protocols are needed to establish best evidence-based practices.

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Effect of Wendler glottoplasty on voice and quality of life of transgender women

Cited by 12 publications

References 44 publications

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort

Scarless Neck Feminization by Transoral Endoscopic Vestibular Approach Chondrolaryngoplasty: A Prospective Cohort

Factors Associated With Loss of Follow‐Up in Transgender Patients Receiving Vocal Therapy

Current approaches to gender-affirming vocal care

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