Information for patients considering surgery to feminize their voice. Patients are typically male-to-female transgender patients who have tried or are also trying voice therapy.

The following is meant for my patients and is based on my experience. There certainly are regional and individual surgeon variations in style, especially for surgery in the transgender patient.

Definition

Thyrohyoid approximation is a procedure designed to raise a genetic male's voice box higher in the neck, in an attempt to raise the resonance of the pharynx by shortening the pharyngeal chamber.

Indications

The surgery is for patients whose voice pitch is interpreted as male, despite concerted efforts at altering pitch. I have found it useful in transgender patients who can get a satisfactory voice with their own effort, but find it continuously effortful and would like to be able to relax a bit more during conversation or not feel so fatigued at days end. It can be part of feminization laryngoplasty surgery.

Alternatives

This surgery doesn't work or meet the needs of everyone. It is new and as of 2007, it is not being performed elsewhere.

Other approaches include reducing the size of the vocal cord, perhaps with a laser. The theory is that the thinner vocal cord will vibrate at a higher pitch. Women’s vocal cords are both thinner and shorter than men's vocal cords. Another approach is cricothyroid approximation.

Some other surgeons have tried creating a web on the vocal cords. I have seen people with webs from other conditions and I am not impressed with their voices, so I don't plan on trying this procedure myself.

Presurgery

Before the surgery/procedure, a PARQ conference is held with you. This is an acronym for Procedures, Alternatives, Risks and Questions. It means that your surgeon has discussed with you in full detail the reasons for the procedure, the alternative treatments to the procedure, the risks of the procedure and that you have been given ample time to ask questions and are satisfied with those reasons and answers. In addition, an evaluation and examination of your voice box is essential. This involves a skilled examiner listening to and measuring a number of characteristics of your voice. A visual inspection of your mouth, throat and voice box is also performed taking about an hour. Our speech therapist will also spend about an hour with you.

Risks

The general risks of surgery are discussed on the informed consent page. The risks specific to this procedure are similar to those for a cricothyroid approximation.

Procedure

The surgery is performed in an outpatient setting under local or general anesthesia. After you are asleep, an incision is placed parallel to or in a skin crease of your neck over the Adam’s apple.

The thyroid cartilage (Adam's apple) is exposed and the top portion removed. Holes are placed in the thyroid cartilage and in the hyoid bone and when tightened, the voice box is raised higher in the neck.

Recovery

I ask you to rest your voice for a few days and avoid coughing - in an attempt to avoid pulling out the sutures. The younger you are and the sooner you started taking estrogen, the softer your thyroid cartilage may be.

Instructions during healing

Aerobic activity may be resumed after two weeks. No weight lifting for one month.

Benefits and thoughts

I have performed several cases with this as the only procedure. To be successful there needs to be a gap between the thyroid cartilage and the hyoid bone. In some genetic males the voice box is quite low in the neck and can be raised quite a bit. In others the voice box abuts the hyoid bone and I really must remove some of the thyroid cartilage to create a gap for raising the voice box. Mostly I have performed this procedure simultaneously, in conjunction with a feminization laryngoplasty.

I believe the change with this procedure is more subtle than other procedures. There is less risk with this procedure than the other procedures I perform. It does provide a change in the vocal quality not performed by other procedures.