1‐Year Results of Combined Modified Wendler Glottoplasty with Voice Therapy in Transgender Women

Abstract

Background To date, 1‐year evaluation of pitch elevation in patients undergoing modified Wendler glottoplasty (WG) in combination with VT has not been assessed. Objectives To determine whether 1‐year pitch elevation is sustained in patients who undergo modified WG in combination with VT for voice feminization. Methods A retrospective review of patients who underwent WG in combination with voice therapy (VT) was performed from 2016 to 2020. Charts were reviewed for sustained vowel fundamental frequency (F0/a/), speaking fundamental frequency (SF0), and Trans Woman Voice Questionnaire (TWVQ) at preoperative, initial postoperative (3–6 months after surgery), and 12‐month postoperative visits. Results Change in average F0/a/, SF0 and TWVQ was 50.25 Hz, 32.96 Hz, and 32.6 at 12‐months postoperatively compared to preoperative values. Initial and 12‐month postoperative SF0 were significantly higher than preoperative SF0 (Mann–Whitney U test p = 0.0042, p = 0.0010). There was no difference in initial postoperative and 12‐month postoperative SF0 (p = 0.50). TWVQ at 12 months was significantly lower than preoperative TWVQ (ANOVA p < 0.001, Tukey honestly significant difference HSD p < 0.05). Conclusions Pitch elevation remains sustained at one year in patients undergoing modified WG in combination with VT. Modified Wendler glottoplasty combined with VT results in relatively long‐term improvements in voice‐related quality of life and is possibly a beneficial addition in the long‐term management of patients who desire voice feminization. Level of Evidence 4 Laryngoscope, 133:615–620, 2023

Current approaches to gender-affirming vocal care

“…1). Various modifications of the original technique have been described utilizing alternative depth of resection [22], suture materials and placements [23 && ] or using tissue glue and injection medialization as a simpler alternative to endoscopic suturing [24]. The aim of these modifications is to add an element of tension or reduce the mass of the vocal cords, leading to a higher pitch increase.…”

Gender-Affirming Voice Surgery: Considerations for Surgical Intervention

“…Most currently published studies of surgical outcomes reflect the combined effects of voice therapy and surgical intervention. [28][29][30][31] It is therefore recommended by the authors herein that patients be encouraged to engage in voice therapy, ideally with a voice specialized SLP who has experience treating gender expansive individuals with concerns of incongruence between voice, communication, and gender. While access to high-quality voice therapy remains a barrier to treatment, the use of teletherapy maybe an alternative to in-person therapy and increase access to specialize voice therapy care.…”

“…26 There are a growing number of studies emphasizing the possible benefits of combining surgical treatment with voice therapy. 28,29,33 While a trial of voice therapy before surgery can be quite beneficial, standardizing an absolute requirement or number of preoperative voice therapy sessions is not suggested. In general, however, the literature suggests that some degree of meaningful progress with voice therapy is often observed within four to six therapy sessions.…”

“…In general, however, the literature suggests that some degree of meaningful progress with voice therapy is often observed within four to six therapy sessions. 29 Patient autonomy and shared decision-making should be the focus of establishing a treatment regimen. For this reason, assessment in a joint multidisciplinary clinic can assist transgender individuals with making informed decisions that best align with their individual goals and likelihood of improvement with voice therapy techniques.…”

“…This surgery has been extensively studied and favorable results have been reported by many different surgical groups and long-term benefit has been documented in the peer-reviewed literature. 29,31,38,[42][43][44] In theory, this procedure could be reversed in a similar manner for which iatrogenic anterior glottal webs are treated. The surgery is done under general anesthesia and is typically performed as an outpatient surgery with no incisions in the neck.…”