European Archives of Oto-Rhino-Laryngology

, Volume 271, Issue 6, pp 1621–1629 | Cite as

Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension

  • Matthew R. Hoffman
  • Erin E. Devine
  • Marc Remacle
  • Charles N. Ford
  • Elizabeth Wadium
  • Jack J. JiangEmail author


To evaluate type IIIB thyroplasty using the excised larynx bench apparatus and determine how altering vocal fold contour by performing bilateral medialization of the inferior vocal fold affects phonation. This procedure could be performed in patients for whom pitch lowering is desirable, such as female-to-male transsexuals or male patients with mutational falsetto in whom intensive voice therapy was insufficient. Aerodynamic, acoustic, and high-speed videokymographic data were collected for nine larynges at three subglottal pressure inputs for each of three conditions: normal; type IIIB thyroplasty; and combined type IIIB with modified bilateral type I thyroplasty intended to create a more rectangular glottal configuration. Each larynx served as its own control. Phonation threshold flow (p = 0.005), phonation threshold power (p = 0.031), and airflow varied across conditions with highest values for type IIIB thyroplasty and lowest for the combined procedure. Fundamental frequency was significantly different (p < 0.001), decreasing by approximately 100 Hz from control to type IIIB trials, and then by approximately 15 Hz from IIIB to combined procedure trials. Vibratory amplitudes and intrafold phase difference were highest for type IIIB trials. Addition of bilateral inferior medialization to type IIIB thyroplasty provided some further decrease in frequency, but mostly served to increase tension, reduce airflow, and produce a vibratory pattern which more closely mirrored control trials. Exploration of this combined procedure in patients may be warranted if not completely satisfied with the results from type IIIB thyroplasty alone.


Type IIIB thyroplasty Type I thyroplasty Pitch lowering Mutational falsetto Transgender phonosurgery 



This study was funded by National Institutes of Health Grant Numbers F31 DC012495 and R01 DC008153 from the National Institute on Deafness and other Communicative Disorders.


  1. 1.
    Anderson J (2007) Endoscopic laryngeal web formation for pitch elevation. J Otolaryngol 36(1):6–12PubMedCrossRefGoogle Scholar
  2. 2.
    Chung D, Tsuji DH, Sennes LU, Imamura R (2007) Upper displacement of the anterior commissure: experimental study of a new phonosurgical approach to raising vocal pitch. Ann Otol Rhinol Laryngol 116(6):462–470PubMedGoogle Scholar
  3. 3.
    Gross M (1999) Pitch-raising surgery in male-to-female transsexuals. J Voice 13:246–250PubMedCrossRefGoogle Scholar
  4. 4.
    Orloff LA, Mann AP, Damrose JF, Goldman SN (2006) Laser-assisted voice adjustment (LAVA) in transsexuals. Laryngoscope 116:655–660PubMedCrossRefGoogle Scholar
  5. 5.
    Tucker HM (1988) Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 97:547–549Google Scholar
  6. 6.
    Remacle M, Matar N, Morsomme D, Veduyckt I, Lawson G (2011) Glottoplasty for male-to-female transsexualism: voice results. J Voice 25(1):120–123PubMedCrossRefGoogle Scholar
  7. 7.
    Isshiki N, Taira T, Tanabe M (1983) Surgical alteration of vocal pitch. J Otolaryngol 12:135–154Google Scholar
  8. 8.
    Wendler J (1990) Vocal pitch elevation after transexualism male to female. In: Proceedings of the Union of the European Phoniatricians, Salsomaggiore, ItalyGoogle Scholar
  9. 9.
    Yang CY, Palmer AD, Murray KD, Meltzer TR, Cohen JI (2002) Cricothyroid approximation to elevate vocal pitch in male-to-female transsexuals: results of surgery. Ann Otol Rhinol Laryngol 111:477–485PubMedGoogle Scholar
  10. 10.
    Wagner I, Fugain C, Monneron-Girard L, Cordier B, Chabolle F (2003) Pitch-raising surgery in fourteen male-to-female transsexuals. Laryngoscope 113:1157–1165PubMedCrossRefGoogle Scholar
  11. 11.
    Leinung MC, Urizar MF, Patel N, Sood SC (2013) Endocrine treatment of transsexual persons: extensive personal experience. Endocr Pract 19:1–22Google Scholar
  12. 12.
    De Cuypere G, Van Hemelrijck M, Michel A, Carael B, Heylens G, Rubens R (2007) Prevalence and demography of transsexualism in Belgium. Eur Psychiatry 22:137–141PubMedCrossRefGoogle Scholar
  13. 13.
    Tsoi WF (1992) Male and female transsexuals: a comparison. Singapore Med J 33:182–185PubMedGoogle Scholar
  14. 14.
    Olsson SE, Moller AR (2003) On the incidence and sex ratio of transsexualism in Sweden, 1972–2002. Arch Sex Behav 32:381–386PubMedCrossRefGoogle Scholar
  15. 15.
    Landen M, Walinder J, Lundstrom B (1996) Prevalence, incidence and sex ratio of transsexualism. Acta Psychiatr Scand 93:221–223PubMedCrossRefGoogle Scholar
  16. 16.
    Soderpalm E, Larsson AK, Almquist SA (2004) Evaluation of a conservative group of transsexual individuals referred for vocal intervention in the west of Sweden. Logoped Phoniatr Vocol 29:18–30PubMedCrossRefGoogle Scholar
  17. 17.
    Kurz S (1993) Een poppenhuis heb ik nooit willen hebben. In: Kamprad B, SchiVels W (eds) Het verkeerde lichaam: Alles over transseksualiteit. Ambo, Baarn, pp 31–44Google Scholar
  18. 18.
    Van Borsel J, De Cuypere G, Rubens R, Destaerke B (2000) Voice problems in female-to-male transsexuals. Int J Lang Commun Disord 35:427–442PubMedCrossRefGoogle Scholar
  19. 19.
    McNeill EJM, Wilson JA, Clark S, Deakin J (2008) Perception of voice in the transgender client. J Voice 22(6):727–733PubMedCrossRefGoogle Scholar
  20. 20.
    Hancock AB, Krissinger J, Owen K (2011) Voice perceptions and quality of life of transgender people. J Voice 25(5):553–558PubMedCrossRefGoogle Scholar
  21. 21.
    Dagli M, Sati I, Acar A, Stone RE Jr, Dursun G, Eryilmaz A (2008) Mutational falsetto: intervention outcomes in 45 patients. J Laryngol Otol 122:277–281PubMedCrossRefGoogle Scholar
  22. 22.
    Kaplan SL (1982) Mutational falsetto. J Am Acad Child Psychiatry 21:82–85PubMedCrossRefGoogle Scholar
  23. 23.
    Prathanee B (1996) Mutational falsetto voices: voice therapy. J Med Assoc Thai 79:388–394PubMedGoogle Scholar
  24. 24.
    Remacle M, Matar N, Verduyckt I, Lawson G (2010) Relaxation thyroplasty for mutational falsetto treatment. Ann Otol Rhinol Laryngol 119(2):105–109PubMedGoogle Scholar
  25. 25.
    Friedrich G, de Jong FI, Majieu HF, Benninger MS, Isshiki N (2001) Laryngeal framework surgery: a proposal for classification and nomenclature by the Phonosurgery Committee of the European Laryngological Society. Eur Arch Otorhinolaryngol 258:389–396PubMedCrossRefGoogle Scholar
  26. 26.
    Isshiki N, Morita H, Okamura H, Hiramoto M (1974) Thyroplasty as a new phonosurgical technique. Acta Otolaryngol 78(5-6):451–457PubMedCrossRefGoogle Scholar
  27. 27.
    Andrews M, Schmidt C (1997) Gender presentation: perceptual and acoustical analyses of voice. J Voice 11:307–313PubMedCrossRefGoogle Scholar
  28. 28.
    Titze IR (2000) Principles of voice production. National Center for Voice and Speech, Iowa CityGoogle Scholar
  29. 29.
    Jiang JJ, Titze IR (1993) A methodological study of hemilaryngeal phonation. Laryngoscope 103:872–882PubMedCrossRefGoogle Scholar
  30. 30.
    Krausert CR, Ying D, Zhang Y, Jiang JJ (2011) Quantitative study of vibrational symmetry of injured vocal folds via digital kymography in excised canine larynges. J Speech Lang Hear Res 54(4):1022–1038PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Matthew R. Hoffman
    • 1
  • Erin E. Devine
    • 1
  • Marc Remacle
    • 2
  • Charles N. Ford
    • 1
  • Elizabeth Wadium
    • 1
  • Jack J. Jiang
    • 1
    Email author
  1. 1.Division of Otolaryngology, Head and Neck Surgery, Department of SurgeryUniversity of Wisconsin-Madison School of Medicine and Public HealthMadisonUSA
  2. 2.Department of Otorhinolaryngology, Head and Neck SurgeryLouvain University Hospital of Mont-GodinneYvoirBelgium

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