Objective To evaluate the indications and results of pitch-raising surgery in male-to-female transsexual patients.
Study Design Retrospective study of male-to-female transsexual patients who underwent pitch-raising surgery between 1994 and 2001 at a single institution.
Methods The 14 patients had inadequate improvements after speech therapy alone. After anterior commissure advancement (n = 2), cricothyroid approximation (n = 9), or both (n = 3), results were evaluated subjectively by the patients and speech therapists and objectively by electroglottographic measurement of fundamental frequencies (usual, maximal, and minimal), postoperative gain in usual fundamental frequency, and the percentage of irregularities.
Results Cricothyropexy disruption occurred in two patients. Median follow-up was 6.5 months. Subjective success rates were 78.5% and 71.5% according to the patients and speech therapists, respectively. Usual, maximal, and minimal frequencies increased significantly; median postoperative gain in usual fundamental frequency was 11 Hz. Three of the four patients with a poor objective result continued to smoke after surgery.
Conclusion Pitch-raising surgery induces subjective and objective improvements but should be reserved for patients in whom speech therapy is not sufficiently effective.