Cricothyroid Approximation and Subluxation in 21 Male-to-Female Transsexuals
Article first published online: 3 JAN 2009
Copyright © 2005 The Triological Society
Volume 115, Issue 4, pages 611–618, April 2005
How to Cite
Kanagalingam, J., Georgalas, C., Wood, G. R., Ahluwalia, S., Sandhu, G. and Cheesman, A. D. (2005), Cricothyroid Approximation and Subluxation in 21 Male-to-Female Transsexuals. The Laryngoscope, 115: 611–618. doi: 10.1097/01.mlg.0000161357.12826.33
- Issue published online: 3 JAN 2009
- Article first published online: 3 JAN 2009
- Manuscript Accepted: 23 NOV 2004
- Pitch-raising surgery;
- male-to-female transsexual;
- cricothyroid approximation
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-to-female 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.