Laser-assisted voice adjustment (LAVA) in transsexuals.
OBJECTIVE
The objective of this study was to evaluate results of laser-assisted voice adjustment (LAVA) surgery in male-to-female (MTF) transsexual patients with androphonia.


METHODS
The authors conducted a prospective case-control study of MTFs who underwent CO2 laser vocal fold vaporization between 1997 and 2003. Thirty-one patients were self-referred for voice feminization. Pre- and postoperative evaluations were completed. Patients' voices were recorded to obtain Fo before and after surgery. Voice Handicap Index (VHI) questionnaires were completed by post-LAVA patients. A panel of blinded listeners identified patients as male or female based on samples of connected speech recorded over the telephone.


RESULTS
Mean follow-up (23 weeks) revealed pitch increases averaging 26 Hz. Self-evaluations revealed increases in voice femininity, congruity with self-image, and satisfaction. However, the evaluations also showed decreased vocal quality, loudness, and vocal range. Mean VHI was consistent with VHI scores associated with Reinke's edema. Six of 10 patients were consistently perceived as female.


CONCLUSIONS
LAVA provides a conservative treatment for androphonia. Postoperative voice therapy may optimize outcomes.
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California 94115, USA. lorloff@ohns.ucsf.edu
Lisa A
LA
Orloff
Andrea P
AP
Mann
John F
JF
Damrose
Stephen N
SN
Goldman
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014189:Transsexualism / Q000150:complications / Q000534:rehabilitation*; D016896:Treatment Outcome; D014832:Voice Disorders / Q000209:etiology / Q000601:surgery*; D014833:Voice Quality