Pitch Elevation in Trangendered Patients: Anterior Glottic Web Formation Assisted by Temporary Injection Augmentation

Abstract

Pitch elevation surgery is most often indicated to assist male-to-female transgendered individuals seeking a more feminine voice quality. Behavioral therapy is primary management but if the desired voice quality is not achieved, surgery is offered. Procedures described that raise vocal pitch alter one or more of the main parameters known to physiologically control pitch; vocal fold tension, length, and mass. Web formation with injection augmentation significantly raises vocal pitch in male-to-female transgendered individuals. Retrospective cohort study. This report describes the voice results after anterior web formation with injection augmentation to reduce vocal fold length in a series of 10 transgendered patients. Retrospective review of male-to-female transgendered patients referred to St. Michaels Hospital Voice Clinic, Toronto, Canada for pitch elevation was carried out including demographic data, preoperative and postoperative acoustic data and videostroboscopic evaluation. Comparison between preoperative to postoperative acoustic measures demonstrated a mean increase in fundamental frequency of 110Hz after web formation. Perturbation measures and pitch range were unchanged from before surgery to after surgery. This novel modification for endoscopic anterior web formation has been shown to be a successful procedure for permanent elevation of pitch with little or no morbidity.