Anterior Glottic Web Formation for Voice Feminization: Experience of 27 Patients

Yılmaz, Taner; Kuşçu, Oğuz; Sözen, Tevfik; Süslü, Ahmet Emre

doi:10.1016/j.jvoice.2017.03.006

Cited by 24 publications

(45 citation statements)

References 19 publications

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“…Since that time, several case series and single institution reports have studied objective and subjective outcomes from this surgery. In these reports, postoperative mean fundamental frequency ranged from 195 Hz to 238 Hz . One report of 362 patients also demonstrated reduction of Voice Handicap Index (VHI) scores in all three domains, but a smaller series of 21 patients showed no significant decrease in VHI .…”

Section: Discussionmentioning

confidence: 99%

“…One report of 362 patients also demonstrated reduction of Voice Handicap Index (VHI) scores in all three domains, but a smaller series of 21 patients showed no significant decrease in VHI . There have been consistent reports of decreased vocal loudness, and this technique has also been associated with vocal roughness that may be improved after voice therapy . One study compared patients who underwent postoperative voice therapy with those who did not and showed both improved vocal quality and improved frequency increase in patients who complied with voice therapy …”

Section: Discussionmentioning

confidence: 99%

“…In these reports, postoperative mean fundamental frequency ranged from 195 Hz to 238 Hz. 18,[22][23][24]29 One report of 362 patients also demonstrated reduction of Voice Handicap Index (VHI) scores in all three domains, 29 but a smaller series of 21 patients showed no significant decrease in VHI. 22 There have been consistent reports of decreased vocal loudness, and this technique has also been associated with vocal roughness that may be improved after voice therapy.…”

Section: Discussionmentioning

confidence: 99%

“…22 There have been consistent reports of decreased vocal loudness, and this technique has also been associated with vocal roughness that may be improved after voice therapy. 20,24 One study compared patients who underwent postoperative voice therapy with those who did not and showed both improved vocal quality and improved frequency increase in patients who complied with voice therapy. 29 Voice therapy alone is also useful for achieving a feminized voice, and many patients are satisfied by their nonsurgical voice change.…”

Section: Discussionmentioning

confidence: 99%

“…Creation of an anterior glottic web shortens the vocal folds to increase vocal frequency. Reports of individual surgeon techniques range from 30% to 50% shortening of the membranous vocal folds . Although more web should theoretically produce more significant pitch elevation, there remains concern for airway narrowing and obstruction with increasing percent web formation.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Rohlfing

Kuperstock

Friedman³

et al. 2019

The Laryngoscope

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Objective Perceived gender identity is correctly assigned when a combination of physical and vocal attributes become congruent. Several voice feminization procedures have gained popularity, but current evidence of their impact on vocal feminization is limited to case series. This study establishes an ex vivo porcine phonatory model to evaluate the ideal extent of anterior glottic web formation in relation to frequency elevation and airway patency. Methods Six fresh porcine larynges were obtained and fitted with arytenoid adduction sutures. Compressed air was passed through the larynges, and the vocal folds were adducted to induce phonation. Vocal fold length, posterior glottic width, fundamental frequency, and sound pressure intensity were measured as the vocal folds were progressively shortened as per the anterior glottic web surgical technique. Results The average fundamental frequency prior to web formation was 109.7 Hz. The maximum frequency achieved after web formation was 403.7 Hz, and the web proportions varied from 11.8% to 61.0% of the length of the membranous vocal folds. The glottic cross‐sectional area showed an expected inverse linear relationship to the length of the glottic web. Creation of an anterior glottic web caused consistent elevation of pitch, but there was a gradual plateau of effect with increased length of the web. Conclusion The ex vivo porcine larynx is demonstrated as an effective, available, and low‐cost model for further study of vocal pitch elevation surgical techniques. We demonstrate that in addition to progressively reducing the cross‐sectional area of the airway, additional benefit from increased web length is limited. Level of Evidence NA Laryngoscope, 130:E206–E212, 2020

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Rohlfing

Kuperstock

Friedman³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

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Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

et al. 2023

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ImportanceGender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy.ObjectiveTo identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation.Evidence ReviewIn this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080).FindingsIn total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate.Conclusions and RelevanceIn this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.

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Vocal Tradeoffs in Anterior Glottoplasty for Voice Feminization

2020

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Objectives/Hypothesis Anterior (Wendler) glottoplasty has become a popular surgery for voice feminization. However, there has been some discrepancy between its theoretical pitch‐raising potential and what is actually achievable, and downsides to shortening the glottis have not been fully explored. In addition, descriptions of the surgery are inconsistent in their treatment of the vocal ligament. This study aimed to determine 1) how fundamental frequency (fo) is expected to vary with length of anterior glottic fixation, 2) the impact of glottic shortening on sound pressure level (SPL), and 3) the effect of including the ligament in fixation. Study Design Computational simulation. Methods Voice production was simulated in a fiber‐gel finite element computational model using canonical male vocal fold geometry incorporating a three‐layer vocal fold composition (superficial lamina propria, vocal ligament, and thyroarytenoid muscle). Progressive anterior glottic fixation (0, 1/8, 2/8, 3/8, etc. up to 7/8 of membranous vocal fold length) was simulated. Outcome measures were fo, SPL, and glottal flow waveforms. Results fo increased from 110 Hz to 164 Hz when the anterior one‐half vocal fold was fixed and continued to progressively rise with further fixation. SPL progressively decreased beyond 1/8 to 1/4 fixation. Inclusion of the vocal ligament in fixation did not further increase fo. Any fixation increased aperiodicity in the acoustic signal. Conclusions The optimal length of fixation is a compromise between pitch elevation and reduction in output acoustic power. The simulation also provided a potential explanation for vocal roughness that is sometimes noted after anterior glottoplasty. Level of Evidence NA Laryngoscope, 131:1081–1087, 2021

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Anterior Glottic Web Formation for Voice Feminization: Experience of 27 Patients

Cited by 24 publications

References 19 publications

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

An ex vivo porcine model of the anterior glottoplasty for voice feminization surgery

Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide

Vocal Tradeoffs in Anterior Glottoplasty for Voice Feminization

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