Effect of Wendler Glottoplasty on Acoustic Measures of Voice

Abstract

Objectives Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice. Study Design Retrospective case series. Methods Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre‐ and postoperative measures were taken with the Kay Elemetrics Real‐Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program. Results Twenty‐eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise‐to‐harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P < .05. Average speaking fundamental frequency (SF0) increased from 143 Hz after voice therapy to 163 Hz after surgery (P = .0009). Lower range decreased in 61% and increased in 26% of patients. Upper range decreased in 52% and increased in 48% of patients. Conclusions Wendler glottoplasty does not worsen voice quality based on acoustic measures. Although most patients experience an increase in average SF0, effects on vocal range are variable with approximately half of patients experiencing a reduction and half experiencing an increase in upper pitch limit. Level of Evidence 4 Laryngoscope, 131:583–586, 2021

Gender Affirming Voice Care: A Literature Review

“…In a series of 28 patients, no change in cepstral peak prominence, cepstral index of dysphonia, noise to harmonic ratio, or soft phonation index was detected after glottoplasty. 48 Similarly, another study of 362 patients undergoing glottoplasty showed no change in noise to harmonic ratio and slight improvement in soft phonation index. 45 Although arguments could be made regarding the sensitivity of perceptual evaluation versus acoustic measurements and the clinical significance of a 0.44 point worsening in dysphonia, it is possible that the difference in postoperative dysphonia may be related to differences in technique.…”

“…38,46,47 Similar to CTA, numerous studies have reported successful pitch elevation following WG ranging from 20 to 81 Hz. 38,45,47,48 Variation in these outcomes may be due to variation in patient age and an additional pitch elevation effect from postoperative voice therapy. The studies from Kim and Mastronikolis et al included postoperative voice therapy and reported the higher pitch elevation outcomes of 74 to 81Hz.…”

“…45,47 However, a study excluding the effects of voice therapy showed no correlation with age and postoperative pitch or change in pitch. 48 Unlike CTA, pitch elevation after WG appears to be long lasting and improvement in quality of life specific to transgender women after WG is well documented. One study of patients undergoing WG showed similar pitch elevation from the 1 month postoperative evaluation to the last follow-up time point at 4 years.…”

“…One study of patients undergoing WG showed similar pitch elevation from the 1 month postoperative evaluation to the last follow-up time point at 4 years. 38 Additionally, multiple studies have found improvement in TWVQ 46,48 as well as VHI. 38,45,48 Figs 1A to C: Wendler glottoplasty technique.…”

“…38 Additionally, multiple studies have found improvement in TWVQ 46,48 as well as VHI. 38,45,48 Figs 1A to C: Wendler glottoplasty technique. Prior to incision (A), after removal of the anterior medial vocal fold mucosa (B), and after suturing the anterior vocal folds together at the completion of surgery (C).…”