Voice feminization in male-to-female transgendered clients after Wendler’s glottoplasty with vs. without voice therapy support

Abstract

The objective of this study was to evaluate the medium-term results of Wendler's glottoplasty surgery (WG) and the effects of post-operative voice therapy in a group of male-to-female transsexuals. This is a retrospective study of 18 transsexuals who voluntarily underwent WG between 2010 and 2014 at a single hospital. Ten of the subjects underwent an additional voice therapy training. The group was assessed pre- vs. post-treatments with a limited battery of measures consisting of fundamental frequency (Fo), maximum phonation time, the TSEQ transgender self-assessment questionnaire, and perceptual assessment of the voice (Visual Analog Scale and a simplified version of the classical Hirano-GRBAS scale) by inter-rater agreement. The surgical procedure consisted of a de-epithelialization of the anterior third of both vocal folds; this area was sutured, and the surface of both vocal folds was vaporized with a laser diode. The results showed a significant increase in vocal tone and feminization of voice in all participants, including a significant increase in Fo 12 months after treatment. Significant improvements were also shown in other evaluated measures, such as self-reported satisfaction and the degree of feminization of the voice. However, no improvements in maximum phonation time were observed. The use of voice therapy appears decisive for optimal improvement of this class of patients. WG applied appropriately by well-trained hands is thus a very effective and less traumatic procedure than other techniques that aim for an acceptable feminization of the voice in MtoF transgendered clients.

Standards of Care for the Health of Transgender and Gender Diverse People, Version 8

“…Two types of laryngeal surgeries are relevant for TGD populations: those for raising voice pitch (e.g., glottoplasty with retro-displacement of the anterior commissure, cricothyroid approximation (CTA), feminization laryngoplasty, laser-assisted voice adjustment (LAVA)) (Anderson, 2007 ; Anderson, 2014 ; Brown, 2000 ; Casado, 2017 ; Geneid, 2015 ; Gross, 1999 ; Kelly et al., 2018 ; Kanagalingam, 2005 ; Kim, 2017 ; Kim, 2020 ; Kocak, 2010; Kunachak, 2000 ; Mastronikolis, 2013 ; Mastronikolis et al., 2013 ; Matai, 2003 ; Meister, 2017; Mora, 2018 ; Neumann, 2004; Nuyen et al., 2022 ; Orloff, 2006 ; Pickuth, 2000 ; Remacle, 2011 ; Thomas & MacMillan, 2013 ; Tschan, 2016 ; Van Borsel, 2008 ; Wagner, 2003 ; Wendler, 1990 ; Yang, 2002 ) and for lowering voice pitch (e.g., thyroplasty type III, vocal fold injection augmentation) (Bultynck et al, 2020 ; Isshiki et al., 1983 ; Kojima, et al. 2008 ; Webb et al., 2021).…”

“…There are more techniques and studies of pitch-raising surgeries, but the quality of the evidence is still low. Outcomes from pitch-raising surgeries have been compared to outcomes from having no surgery (Anderson, 2007 , 2014 ; Brown et al., 2000 ; Geneid et al., 2015 ; Gross, 1999 ; Kim, 2017 ; Kocak et al., 2010; Kunachak et al., 2000 ; Matai et al., 2003 ; Meister et al., 2017; Neumann & Welzel, 2004 ; Orloff et al., 2006 ; Pickuth et al., 2000 ; Remacle et al., 2011 ; Thomas & Macmillan, 2013 ; Tschan et al., 2016 ; Van Borsel et al., 2008 ; Yang et al., 2002 ), another type of surgical technique (Mora, 2018 ), voice training alone (Kanagalingam, 2005 ; Mastronikolis, 2013 ; Wagner, 2003 ) and surgery in conjunction with voice training (Casado, 2017 ; Kelly et al., 2018 ).…”

Fonoterapia para mulheres transgênero

“…Quatro estudos (Remacle, Matar, Morsomme, Veduickt, & Lawson, 2011;Mastronikolis, Remacle, Biagini, Kiagiadaki, & Lawson, 2013;Casado, Rodríguez-Parra, & Adrián, 2017;Meister, Hagen, Shehata-Dieler, Kühn, Kraus, & Kleinsasser, 2017) descreveram a cirurgia na laringe para a mudança vocal de mulheres transgênero por meio da técnica de Wendler, que consiste na ressecção do epitélio do terço anterior das pregas vocais e de sutura em forma de "V", promovendo o encurtamento e a consequente diminuição da massa vibratória. Todos encontraram aumento significativo da f0 média, porém ressaltou-se a importância da associação à terapia fonoaudiológica, a fim de melhorar o novo comportamento vocal, adaptar o sujeito à nova f0 da voz, ampliar a tessitura vocal e adequar certos marcadores femininos de fala (Mastronikolis, Remacle, Biagini, Kiagiadaki, & Lawson, 2013;Casado, Rodríguez-Parra, & Adrián, 2017).…”

Intervención logopédica en la feminización de la voz en transexuales: revisión bibliográfica

“…Se descartan otros 9, por hacer referencia a intervenciones médico-quirúrgicas para el tratamiento de la voz transexual (Anderson, 2014;Casado et al, 2016;Casado, Rodríguez-Parra, & Adrián, 2017;Kim, 2017;Mastronikolis, Remacle, Biagini, Kiagiadaki, & Lawson, 2013;Schwarz, Fontanari, Schneider, et al, 2017;Song & Jiang, 2017). Finalmente, se prescinde del análisis de un artículo en finés al cual no se tiene acceso y no es posible evaluar si cumple estrictamente los criterios de inclusión (Sellman & Rihkanen, 2015).…”