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Objectives: Gains in pitch from gender affirming voice training (GVT) alone in trans women have historically been shown to decline after 1 year. Currently no standard exists for length and type of GVT that yields meaningful behavioral change and patient satisfaction with voice outcomes in trans women. This study aims to determine whether GVT alone leads to sustained pitch elevation and patient satisfaction in trans women. Methods: Retrospective review from 2016 to 2020 of trans women patients who underwent GVT alone for voice change. Charts were reviewed for acoustic analysis of pitch including sustained vowel fundamental frequency, speaking fundamental frequency, and quality of life data from the Trans Woman Voice Questionnaire at pre‐therapy, immediate post‐therapy, and extended post‐therapy time intervals. Results: A total of 157 patients presented to our Voice Center, of which 34 participated in the full course of GVT. Patients underwent an average of six sessions of GVT (range 5–7) over an average of 13.14 weeks (range 6–16). Average time between completing GVT and presenting for extended follow‐up was 11.37 months (range 6–31). Compared to initial presentation prior to therapy, at extended follow‐up after completing GVT average change in F0/a/, SF0, and TWVQ were 64.6 Hz, 31.3 Hz, and 32.45. No significant change was noted between immediate post‐therapy and extended post‐therapy acoustic measures. TWVQ demonstrated continued improvement between immediate post‐therapy and extended post‐therapy. Conclusions: In self‐selected patients who present for extended follow‐up, GVT alone can result in sustained pitch elevation and voice‐related quality life in trans women. Level of Evidence: 4 Laryngoscope, 133:2340–2345, 2023 This study aims to determine whether VT alone leads to sustained pitch elevation and patient satisfaction in trans women. Retrospective review from 2016‐2020 of trans women patients who underwent VT alone for voice change. Compared to initial presentation prior to therapy, at extended follow‐up after completing VT average change in F0/a/, SF0 and TWVQ were 64.6 Hz, 31.3 Hz, and 32.45. In self‐selected patients who present for extended follow‐up, VT alone can result in sustained pitch elevation and voice‐related quality life in trans women. [ABSTRACT FROM AUTHOR]

Background: To date, 1‐year evaluation of pitch elevation in patients undergoing modified Wendler glottoplasty (WG) in combination with VT has not been assessed. Objectives: To determine whether 1‐year pitch elevation is sustained in patients who undergo modified WG in combination with VT for voice feminization. Methods: A retrospective review of patients who underwent WG in combination with voice therapy (VT) was performed from 2016 to 2020. Charts were reviewed for sustained vowel fundamental frequency (F0/a/), speaking fundamental frequency (SF0), and Trans Woman Voice Questionnaire (TWVQ) at preoperative, initial postoperative (3–6 months after surgery), and 12‐month postoperative visits. Results: Change in average F0/a/, SF0 and TWVQ was 50.25 Hz, 32.96 Hz, and 32.6 at 12‐months postoperatively compared to preoperative values. Initial and 12‐month postoperative SF0 were significantly higher than preoperative SF0 (Mann–Whitney U test p = 0.0042, p = 0.0010). There was no difference in initial postoperative and 12‐month postoperative SF0 (p = 0.50). TWVQ at 12 months was significantly lower than preoperative TWVQ (ANOVA p < 0.001, Tukey honestly significant difference HSD p < 0.05). Conclusions: Pitch elevation remains sustained at one year in patients undergoing modified WG in combination with VT. Modified Wendler glottoplasty combined with VT results in relatively long‐term improvements in voice‐related quality of life and is possibly a beneficial addition in the long‐term management of patients who desire voice feminization. Level of Evidence: 4 Laryngoscope, 133:615–620, 2023 [ABSTRACT FROM AUTHOR]

Objectives/Hypothesis: VT is often considered the preferred treatment for vocal feminization in transgender patients. However, Wendler glottoplasty offers a surgical option for increasing fundamental frequency and perception of vocal femininity. We aimed to determine whether the addition of glottoplasty to VT results in greater fundamental frequency elevation and improvement in quality‐of‐life measures. Study Design: Retrospective case series. Methods: Forty‐eight trans female patients were treated for vocal feminization. Twenty‐seven patients underwent VT, and 21 patients underwent VT with additional glottoplasty (VTWG). Pre‐ and posttreatment acoustic measures, Trans Woman Voice Questionnaire (TWVQ), and Voice Handicap Index‐10 (VHI‐10) data were compared. Results: Glottoplasty in combination with VT elevated average speaking fundamental frequency (SF0) to a greater extent than VT alone (P <.0001). The VTWG group achieved a 42‐Hz increase in SF0, whereas the VT group achieved a 15‐Hz increase in SF0. In both the VT and VTWG groups, the lower bound of physiologic range increased by 18 Hz (P =.0008 and P =.016, respectively). The addition of glottoplasty also resulted in greater improvement in voice‐related quality of life. Improvement in TWVQ and VHI‐10 was significantly greater in the VTWG group than the VT group (P =.007 and P =.029, respectively). TWVQ showed statistically significant improvement in the VTWG group only. Conclusions: VT results in SF0 elevation and improvement in VHI‐10. The addition of glottoplasty to VT results in further improvements in SF0 and VHI‐10 and statistically significant improvement in TWVQ. Level of Evidence: 4 Laryngoscope, 131:1588–1593, 2021 [ABSTRACT FROM AUTHOR]

Objectives: Voice therapy has been the primary treatment for voice feminization in transfemale patients due to concerns that surgery worsens voice quality. We aim to determine the impact of Wendler glottoplasty on acoustic measures of voice.Study Design: Retrospective case series.Methods: Transgender female patients treated for vocal feminization with Wendler glottoplasty at a single tertiary care center were identified. Pre- and postoperative measures were taken with the Kay Elemetrics Real-Time Pitch, Analysis of Dysphonia in Speech and Voice, and Multidimensional Voice Program.Results: Twenty-eight patients were included in this study. There were no statistically significant changes in fundamental frequency variation, peak amplitude variation, soft phonation index, noise-to-harmonics ratio, cepstral peak prominence, or cepstral spectral index of dysphonia at a significance level of P < .05. Average speaking fundamental frequency (SF0) increased from 143 Hz after voice therapy to 163 Hz after surgery (P = .0009). Lower range decreased in 61% and increased in 26% of patients. Upper range decreased in 52% and increased in 48% of patients.Conclusions: Wendler glottoplasty does not worsen voice quality based on acoustic measures. Although most patients experience an increase in average SF0, effects on vocal range are variable with approximately half of patients experiencing a reduction and half experiencing an increase in upper pitch limit.Level Of Evidence: 4 Laryngoscope, 131:583-586, 2021. [ABSTRACT FROM AUTHOR]