Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch

Abstract

In this study, we aimed to assess the long-term effects of the mucosal layer plastic surgery of the vocal folds performed on the voices of male-to-female transgenders. This retrospective cohort study enrolled 22 patients who were operated during 2004-2010 by a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using CO2 laser. Long-term effects were assessed based on completed questionnaires on four different categories including subjective evaluation of patient's own voice perception and a standardized voice inventory (VHI), as well as an acoustic assessment and videolaryngoscopic examination. Out of the 22 patients contacted, 16 returned the questionnaires, and 13 of them participated in the subsequent acoustic analysis and videolaryngoscopic assessment. Results of the study were as follows: The total VHI score, after the procedure, was 32. F0 increased significantly for both the vowel/a/ and text from 157 to 207 Hz and 139 to 162 Hz, respectively. Perturbation measures did not show a significant change. F0 did not correlate with the VHI score. One patient had symptomatic anterior perforation that needed re-operation. The combination of transmucosal anterior suturing and stiffening of the vocal folds by laser cordectomy results in significant elevation of the F0 in the long term and in acceptable levels of VHI score compared to other reports. In conclusion, the results of the procedures show that it is enough to get the mucosal edges sutured together without the need to suture either the ligaments or the muscle of the vocal folds. The need for revision is minimal with this procedure.

Associations between the Transsexual Voice Questionnaire (TVQMtF) and self‐report of voice femininity and acoustic voice measures

“…Geneid et al . () reported no correlation between mean F0 and VHI score. The findings of Remacle et al .…”

“…Self‐report tools are particularly important when assessing the vocal needs of the MtF woman as clinician evaluations of her voice do not necessarily reflect how her voice impacts on her everyday life (Geneid et al . , Remacle et al . ).…”

Laryngeal surgical treatment in transgender women: A systematic review and meta‐analysis

“…In addition to these procedures, the systematic review showed that other studies using surgical intervention performed over the past 10 years to increase the f0 in transsexual women were not included in the metaanalysis because they did not have a control group. The surgical procedures included cricothyroid approximation and subluxation, 4 laser-assisted voice adjustment, 7 Wendler glottoplasty, 25 anterior glottic web formation assisted by temporary injection augmentation, 26 a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using a CO2 laser, 15 Wendler glottoplasty and voice therapy, 27 and cricoid-thyroid approximation. 28 This study also highlighted that at the presurgical time (Table IV), none of the studies had an EG (experimental group) with f0 within the range considered female (150-250 Hz), except the CG (control group) of one study that was composed of cis-sexual women.…”

“…These procedures often are implemented when the speech therapy was not satisfactory and the individual is constrained by not being able to sustain an f0 without fatigue—or by having a deep pitch during laughter, coughing, yawning, screaming, or throat‐clearing. Moreover, after surgical elevation of f0, the individual does not need to think about the voice frequency or imitate female voices …”

“…Moreover, after surgical elevation of f0, the individual does not need to think about the voice frequency or imitate female voices. 7,15 Given that research is inconclusive about which communication parameters are sexually dimorphic and about the best treatment for vocal feminization, this meta-analysis aims to identify and discuss the effects of the laryngeal surgical treatment of the voice in transsexual women. Thus, we seek to systematically analyze scientific evidence to provide support for clinical decisions involving voice treatment in transsexual women.…”