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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]

Objectives: The study aimed to evaluate patient satisfaction with speech‐language therapy televisits and to identify factors influencing the level of satisfaction. Methods: Participants were recruited from an academic tertiary voice and swallowing center who had completed ≥1 telehealth session of speech‐language therapy with a speech‐language pathologist between March, 2020 and April, 2021. Patient satisfaction was assessed using the Short Assessment of Patient Satisfaction (SAPS), a validated 7‐item survey. Demographic characteristics of participants were collected from a review of patient charts. Results: 65/239 patients completed the SAPS survey, representing a response rate of 27%. The average age of study participants was 54.92 ± 16.45 years, with 49.2% identifying as female, 33.9% as male, and 16.9% as trans‐female. The mean SAPS score was 22.60 ± 3.89, with 84.62% of patients satisfied or very satisfied with their visit. Patients were most satisfied with provider respect (3.91 ± 0.34) and care received (3.74 ± 0.64), and least satisfied with visit length (2.32 ± 1.38) and explanation of treatment results (2.62 ± 1.72). Patient satisfaction was positively correlated with younger age and an increased number of televisits. Satisfaction did not differ significantly by gender identity, type of therapy received, insurance type, travel distance, or prior in‐person therapy. Conclusion: Clinicians are able to achieve high patient satisfaction with speech‐language therapy when delivered by telehealth. Patient satisfaction remained high across diverse patient populations and range of clinical needs. Clinicians should remain cognizant of the unique limitations of older patients when conducting telehealth visits. Lay Summary: Clinicians are able to achieve high patient satisfaction with speech‐language therapy when delivered via telehealth. Satisfaction remained high regardless of gender identity, type of therapy received, type of insurance, travel distance, or completion of prior in‐person therapy. Level of Evidence: 4 Laryngoscope, 133:895–900, 2023 [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]

Objective: Static endoscopic evaluation of swallowing (SEES) is an instrumental evaluation developed for in‐office identification of patients who may benefit from a modified barium swallow study (MBSS). We aim to determine the predictive value of SEES for evaluating dysphagia. Methods: A retrospective case series was performed on adults evaluated for dysphagia using SEES followed by MBSS at a single tertiary care center. Studies were evaluated by two blinded expert raters. Results: Fifty‐eight patients were included. Thin liquid penetration on SEES had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.86 (95% CI 0.70‐0.95), 0.63 (95% CI 0.24‐0.91), 0.91 (95% CI 0.76‐0.98), and 0.5 (0.19‐0.81), respectively, for predicting thin liquid penetration on MBSS, and 1.0 (95% CI 0.59‐1.0), 0.29 (95% CI 0.15‐0.47), 0.23 (95% CI 0.10‐0.41), and 1.0 (95% CI 0.69‐1.0) for predicting thin liquid aspiration on MBSS. Thin liquid aspiration on SEES had a sensitivity, specificity, PPV, and NPV of 0.67 (95% CI 0.09‐0.99), 0.85 (95% CI 0.66‐0.96), 0.33 (95% CI 0.04‐0.78), and 0.96 (95% CI 0.79‐1.0), respectively, for predicting thin liquid aspiration on MBSS. Conclusions: SEES may be used as an objective in‐office test to screen for aspiration and penetration. Thin liquid penetration on SEES is moderately sensitive for predicting penetration on MBSS. Absence of thin liquid penetration or aspiration on SEES has a high NPV for excluding aspiration on MBSS. Abnormalities on SEES or the need to view the entire swallowing mechanism should prompt an MBSS for a more complete evaluation of dysphagia. Level of Evidence: 4 [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]

Objectives: Formal evaluation of health states related to dysphonia have not been rigorously evaluated in affected patients. The objective of this project was to evaluate the health states of mild, moderate, and severe dysphonia using formal health state preference evaluation, and to compare these outcomes with the degree of voice handicap.Design: Prospective health state preference assessment.Methods: A convenience sample of patients presenting with voice complaints were enrolled from an academic voice center. Demographic and voice handicap index (VHI-10) data were obtained, and an assessment of preference for five health states (monocular blindness, binocular blindness, mild dysphonia, moderate dysphonia, and severe dysphonia) was performed. Utility scores were calculated on a scale from 0 (death) to 1 (perfect health). Analysis was performed with ANOVA testing with post-hoc comparisons and correlation statistics.Results: Of 209 assessments, 149 (75.6%) met quality criteria. Relative to monocular blindness (score 0.61 [CI 0.57-0.64]), moderate dysphonia (0.58 [0.54-0.62]) was rated equivalently, with severe dysphonia (0.33 [0.29-0.37]) ranking significantly worse and mild dysphonia (0.96 [0.95-0.98]) significantly better. Binocular blindness (0.18 [0.15-0.21]) was the worst-ranked health state. There was a weak inverse correlation of VHI-10 with dysphonia-related preference scores; with worsening reported voice handicap, scores decreased.Conclusion: This study demonstrated that dysphonia had a significant impact of quality of life, with moderate dysphonia ranking equivalently with monocular blindness. These numerical estimates may be used for ongoing research into the value and cost-effectiveness of medical, therapeutic, and surgical interventions for voice disorders.Level Of Evidence: 2c (outcomes research) Laryngoscope, 130:E177-E182, 2020. [ABSTRACT FROM AUTHOR]

Objectives: Although patient‐reported outcome measures (PROMs) can be useful for assessing quality of life, they can be complex and cognitively burdensome. In this study, we prospectively evaluated a simple patient‐reported voice assessment measure on a visual analog scale (VAS voice) and compared it with the Voice Handicap Index (VHI‐10). Study design: Prospective survey. Methods: An abbreviated voice measure was designed by a team of otolaryngologists, speech pathologists, and patients that consisted of four VAS questions related to (a) a global question of voice disturbance, (b) physical function of voice, (c) functional issues, and (d) emotional handicap. All English‐speaking patients presenting to an academic laryngology clinic for a voice complaint were included. Internal consistency and validity were assessed with comparison to the VHI‐10. Results: A total of 209 patients were enrolled. Ninety‐two percent of patients reported understanding the survey. The four‐item VAS survey was highly correlated with VHI‐10 score (Pearson correlation.81, P <.0001), and the Cronbach's alpha between all four VAS questions was.94. Age, gender, and diagnosis were not associated with either the global VAS or VHI‐10 tool. Conclusion: Reducing the complexity of instruments assessing voice‐related quality of life is feasible, and the VAS voice correlated with existing measures. Simplified assessments may offer advantages compared to more cumbersome PROMs. Level of Evidence: 2c [ABSTRACT FROM AUTHOR]