Cricothyroid Approximation and Subluxation in 21 Male‐to‐Female Transsexuals

Abstract

Objectives:To evaluate the medium-term outcome of cricothyroid approximation and subluxation (CTAS) with postoperative speech therapy for pitch elevation in male-to-female transsexuals. Study Design: Retrospective study of male-tofemale transsexuals who underwent pitch-raising surgery between November 1996 and August 2001.Methods: Twenty-one male-to-female transsexuals opted for surgical feminization of their voices after inadequate improvements with speech therapy alone. Electrolaryngographic measurements were obtained by a single speech therapist of modal fundamental frequencies and the percentage of irregularities before, at 2 weeks, and 6 months after surgery. All 21 patients underwent CTAS, and 20 underwent simultaneous cosmetic thyroid chondroplasty by a single surgeon. Results: Electrolaryngographic results 2 weeks after surgery showed an average postoperative gain in modal frequency of free speech of 71.05 Hz (95% confidence interval [CI]: 42.9 -99.2, P < .001). There was a concomitant average rise in irregularities of 9.9% (95% CI 0.7-18.5, P ‫؍‬ .03). At median follow-up of 6 months after six sessions of speech therapy (n ‫؍‬ 15), there was a decrease in irregularities to preoperative levels. The overall gain at 6 months in modal frequency of free speech was 56.9 Hz (95% CI 38.3-75.4, P < .001).Smoking and age did not predict a worse outcome. Conclusions: Cricothyroid approximation effectively raises pitch in male-to-female transsexuals.There is a concomitant rise in voice irregularities that is effectively addressed by speech therapy.

Phonetograms, Aerodynamic Measurements, Self-Evaluations, and Auditory Perceptual Ratings of Male-to-Female Transsexual Voice

“…5,7 Sometimes, surgical procedures are used to achieve a higher fundamental frequency (F 0 ). These procedures include cricothyroid approximation, 8 anterior commissure advancement, and endolaryngeal shortening of the vocal folds. 9 However, although surgery can assist in raising the F 0 , it is not problem-free and seldom sufficient to create a totally female voice.…”

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 meta‐analysis because they did not have a control group. The surgical procedures included cricothyroid approximation and subluxation, laser‐assisted voice adjustment, Wendler glottoplasty, anterior glottic web formation assisted by temporary injection augmentation, a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using a CO2 laser, Wendler glottoplasty and voice therapy, and cricoid‐thyroid approximation …”

Laser Reduction Glottoplasty for Managing Androphonia After Failed Cricothyroid Approximation Surgery

“…The tension and FF are highest in the early postoperative period, and then decrease over time because of temporal mechanical factors, such as stress relaxation. 5,8,17 Therefore, the late results are more important for evaluating the success of the surgery. To overcome the inefficiency of CTA for obtaining the desired feminine pitch, the maximum limits should be applied during surgery.…”