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Vocal Outcomes Following Pitch Alteration Surgeries

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Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript


Our study aims to ascertain the results of speech therapy and surgery in patients who desire pitch alteration. Typically, patients desirous of an increase in their vocal pitch are male-to-female transpersons, and patients desirous of a drop in their pitch are puberphonia patients. This is a 3-year retrospective study of patients who have been operated for pitch alteration. This is a study of seven patients each of Wendlers glottoplasty (WG) and relaxation laryngeal framework surgery (RLFS). The records were reviewed for the preoperative and the 1-year post-operative fundamental frequency (FO), patient subjective satisfaction score (PSSS), and healing time. A total of 7/35 patients of puberphonia underwent RLFS in which the average preoperative F0 was 216 Hz and 1-year post-operative F0 was 114 Hz (p 0.004). The average pre- and post-operative PSSS was 4 and 9 (p 0.0004). Patients of WG had an average preoperative F0 of 153 Hz and 1-year post-operative F0 of 223 Hz (p 0.0005). The average pre and 1-year postoperative PSSS was 4 and 8 (p 0.002). The average healing time was 3 weeks 4 days in the RLFS patients and 8 weeks 5 days for WG patients. The results of RFLS yielded a high PSSS with a pitch drop of more than 100 Hz. The results of WG yielded an increase in the pitch of 70 Hz with a good PSSS. The average healing time taken following WG was double the time taken for RFLS.

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  1. Schwarz K, Fontanari AMV, Schneider MA, Borba Soll BM, da Silva DC, Spritzer PM, Kazumi YamagutiDorfman ME, Kuhl G, Costa AB, Cielo CA, Villas Bôas AP, Lobato MIR (2017) Laryngeal surgical treatment in transgender women: a systematic review and meta-analysis. Laryngoscope 127(11):2596–2603. (Epub 2017 Jul 3. PMID: 28671273)

    Article  PubMed  Google Scholar 

  2. Dacakis G (2002) The role of voice therapy in male-to-female transsexuals. Curr Opin Otolaryngol Head Neck Surg 10(3):173–177

    Article  Google Scholar 

  3. Hamdan AL, Khalifee E, Ghanem A, Jaffal H (2019) Injection laryngoplasty in patients with puberphonia. J Voice 33(4):564–566. (Epub 2018 Oct 29 PMID: 30381145)

    Article  PubMed  Google Scholar 

  4. Liang FY, Huang XM, Chen L, Huang YZ, Zhang XY, Su JH, Wang YJ, Yang JS, Zheng YQ, Mei XS, Guan Z (2017) Voice therapy effect on mutational falsetto patients: a vocal aerodynamic study. J Voice 31(1):114.e1-114.e5. (Epub 2016 Aug 30 PMID: 27589888)

    Article  PubMed  Google Scholar 

  5. Brodnitz FS (1958) The pressure test in mutational voice disturbances. Ann Otol Rhinol Laryngol 67(1):235–240.

    Article  CAS  PubMed  Google Scholar 

  6. Nakamura K, Tsukahara K, Watanabe Y, Komazawa D, Suzuki M (2013) Type 3 thyroplasty for patients with mutational dysphonia. J Voice 27(5):650–654. (Epub 2013 Jun 21 PMID: 23790649)

    Article  PubMed  Google Scholar 

  7. Dagli M, Sati I, Acar A et al (2008) Mutational falsetto: intervention outcomes in 45 patients. J Laryngol Otol 122:277–281

    Article  CAS  PubMed  Google Scholar 

  8. Friedrich G, de Jong FI, Mahieu 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(8):389–396. (PMID: 11724261)

    Article  CAS  PubMed  Google Scholar 

  9. Slavit DH, Maragos NE (1994) Arytenoid adduction and type I thyroplasty in the treatment of aphonia. J Voice 8:84–91

    Article  CAS  PubMed  Google Scholar 

  10. Isshiki N, Morita H, Okamura H, Hiramoto M (1974) Thyroplasty as a new phonosurgical technique. Acta Otolaryngol (Stockh) 78:451–457

    Article  CAS  PubMed  Google Scholar 

  11. Pasternak K, Francis DO (2019) An update on treatment of 518 voice-gender incongruences by otolaryngologists and speech- 519 language pathologists. Curr Opin Otolaryngol Head Neck Surg 520(27):475–481

    Article  Google Scholar 

  12. Aires MM, de Vasconcelos D, Lucena JA, Gomes AOC, Moraes BT (2021) Effect of wendler glottoplasty on voice and quality of life of transgender women. Braz J Otorhinolaryngol. (Epub ahead of print. PMID: 34400103)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Isshiki N, Taira T, Tanabe M (1983) Surgical alteration of the vocal pitch. J Otolaryngol 12:5

    Google Scholar 

  14. Tucker HM (1985) Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 94:547–549

    Article  CAS  PubMed  Google Scholar 

  15. Remacle M, Matar N, Verduyckt I et al (2010) Relaxation thyroplasty for mutational falsetto treatment. Ann Otol Rhinol Laryngol 119:105–109

    Article  PubMed  Google Scholar 

  16. Lejeune FE, Guice CE, Samuels PM (1983) Early experiences with vocal ligament tightening. Ann Otol Rhinol Laryngol 92:475–477

    Article  CAS  PubMed  Google Scholar 

  17. Tucker HM (1988) Anterior commissure laryngoplasty for adjustment of vocal fold tension. Ann Otol Rhinol Laryngol 97:547–549

    Google Scholar 

  18. Orloff LA, Mann AP, Damrose JF, Goldman SN (2006) Laser-assisted voice adjustment (LAVA) in transsexuals. Laryngoscope 116:655–660

    Article  PubMed  Google Scholar 

  19. Kim HT (2020) Vocal feminization for transgender women: current strategies and patient perspectives. Int J Gen Med 12(13):43–52.;PMCID:PMC7024865

    Article  Google Scholar 

  20. Yılmaz T, Kuşçu O, Sözen T, Süslü AE (2017) Anterior glottic web formation for voice feminization: experience of 27 patients. J Voice 31(6):757–762. (Epub 2017 Mar 31 PMID: 28372888)

    Article  PubMed  Google Scholar 

  21. Geneid A, Rihkanen H, Kinnari TJ (2015) Long-term outcome of endoscopic shortening and stiffening of the vocal folds to raise the pitch. Eur Arch Otorhinolaryngol 272:3751–3756

    Article  PubMed  Google Scholar 

  22. Remacle M, Matar N, Morsomme D et al (2011) Glottoplasty for male-to-female transsexualism: voice results. J Voice 25:120–123

    Article  PubMed  Google Scholar 

  23. Casado JC, O’Connor C, Angulo MS et al (2016) Wendler glottoplasty and voice-therapy in male-to-female transsexuals: results in pre and post-surgery assessment. Acta Otorrinolaringol Esp 67:83–92

    Article  PubMed  Google Scholar 

  24. Mastronikolis NS, Remacle M, Biagini M et al (2013) Wendler glottoplasty: an effective pitch raising surgery in male-to-female transsexuals. J Voice 27:516–522

    Article  PubMed  Google Scholar 

  25. Gross M (1999) Pitch-raising surgery in male-to-female transsexuals. J Voice 13:246–250

    Article  CAS  PubMed  Google Scholar 

  26. Van Damme S, Cosyns M, Deman S, Van den Eede Z, Van Borsel J (2017) The effectiveness of pitch-raising surgery in male-to-female transsexuals: a systematic review. J Voice 31(2):244.e1-244.e5. (Epub 2016 Jul 28 PMID: 27474996)

    Article  PubMed  Google Scholar 

  27. Song TE, Jiang N (2017) Transgender phonosurgery: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 156(5):803–808. (Epub 2017 Mar 28 PMID: 28349733)

    Article  PubMed  Google Scholar 

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Correspondence to Nupur Kapoor Nerurkar.

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Nerurkar, N.K., Nagree, Z., Malik, E. et al. Vocal Outcomes Following Pitch Alteration Surgeries. Indian J Otolaryngol Head Neck Surg 75, 2741–2746 (2023).

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