title: Cricothyroid approximation and subluxation in 21 male-to-female transsexuals.
abstract: OBJECTIVE
  To evaluate the medium-term outcome of cricothyroid approximation and subluxation (CTAS) with postoperative speech therapy for pitch elevation in male-to-female transsexuals.
  
  
  METHODS
  Retrospective study of male-to-female transsexuals who underwent pitch-raising surgery between November 1996 and August 2001.
  
  
  METHODS
  Twenty-one male-to-female transsexuals opted for surgical feminization of their voices after inadequate improvements with speech therapy alone. Electrolaryngographic measurements were obtained by a single speech therapist of modal fundamental frequencies and the percentage of irregularities before, at 2 weeks, and 6 months after surgery. All 21 patients underwent CTAS, and 20 underwent simultaneous cosmetic thyroid chondroplasty by a single surgeon.
  
  
  RESULTS
  Electrolaryngographic results 2 weeks after surgery showed an average postoperative gain in modal frequency of free speech of 71.05 Hz (95% confidence interval [CI]: 42.9-99.2, P < .001). There was a concomitant average rise in irregularities of 9.9% (95% CI 0.7-18.5, P = .03). At median follow-up of 6 months after six sessions of speech therapy (n = 15), there was a decrease in irregularities to preoperative levels. The overall gain at 6 months in modal frequency of free speech was 56.9 Hz (95% CI 38.3-75.4, P < .001). Smoking and age did not predict a worse outcome.
  
  
  CONCLUSIONS
  Cricothyroid approximation effectively raises pitch in male-to-female transsexuals. There is a concomitant rise in voice irregularities that is effectively addressed by speech therapy.
authors.affiliation: Royal National Throat Nose and Ear Hospital, London, UK. jeevekana@hotmail.com
authors.forename: Jeeve
authors.initials: J
authors.lastname: Kanagalingam
authors.forename: Christos
authors.initials: C
authors.lastname: Georgalas
authors.forename: Gary R
authors.initials: GR
authors.lastname: Wood
authors.forename: Suki
authors.initials: S
authors.lastname: Ahluwalia
authors.forename: Guri
authors.initials: G
authors.lastname: Sandhu
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Cheesman
mesh_terms: D000328:Adult; D000367:Age Factors; D003413:Cricoid Cartilage / Q000601:surgery*; D004568:Electrodiagnosis; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012907:Smoking / Q000503:physiopathology; D013070:Speech Therapy; D013957:Thyroid Cartilage / Q000601:surgery*; D014189:Transsexualism / Q000503:physiopathology*; D016896:Treatment Outcome; D014831:Voice / Q000502:physiology*; D014833:Voice Quality / Q000502:physiology