Operative voice pitch raising in male-to-female transsexuals. A survey of our technique and results

Abstract

Transsexuality constitutes a complex,permanent transposition due to a paradoxical sense of belonging to the opposite sex. The persons concerned experience such a high degree of suffering that they strive to undergo operative sex reversal. Mainly in the case of male-to-female transsexuals this may often lead to a subsequent discrepancy between the external appearance and the character of the voice,since only a deepening of the voice can be achieved by hormonal treatment and not a raising of its pitch.Also,logopedic treatment on its own cannot,as a rule, guarantee a lasting success. In order to adapt the voice as an essential aspect of human identity to the external female appearance,a variety of phonosurgical operation techniques have been developed since the seventies. In 1993 a modified cricothyroidal approximation via miniplates, following ISSHIKI's technique, has been performed at the ENT Department of the Martin-Luther-University of Halle-Wittenberg. This procedure is based upon an approximation of the cricoid and thyroid cartilages resulting in an increase in the vocal cord tension. This intervention does not affect the inner structures of the larynx and is on principle reversible. Combined with a chondrolaryngoplasty it allows for a reduction of the Adam's apple. So far 57 patients have undergone this surgical intervention. Laryngoscopy, stroboscopy and a detailed voice diagnostic, as well as ultrasound and computertomographic examinations of the larynx are performed pre and postoperatively in order to record the anatomical-physiological and functional data. So far good functional results could be achieved showing an average rise of the medium voice range by approximately one fourth. As a long-term result a permanent raising of the basic voice pitch has been reported. The majority of the patients are satisfied with the functional and cosmetic effect reporting an enhanced self-esteem.