title: Anterior Glottic Web Formation for Voice Feminization: Experience of 27 Patients.
abstract: OBJECTIVE
  Voice feminization is needed for male-to-female transsexuals, males with testicular feminization, and females with constitutional androphonia. Anterior glottic web formation affords advantages: endoscopic surgery without skin incision and scar, outpatient surgery, potential reversibility, and low risk for vocal fold and airway damage.
  
  
  METHODS
  This is a nonrandomized prospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All 27 cases of androphonia were treated with endoscopic anterior glottic web formation. Voice Handicap Index (VHI-30); acoustic analysis with /a/ including F0, jitter, shimmer, noise-to-harmonic ratio; and acoustic analysis of connected speech for speaking F0were determined pre- and postoperatively. Patients and medical students rated pre- and postoperative voices as feminine, masculine, or neither.
  
  
  RESULTS
  The pre- and postoperative mean total VHI scores of patients were 38 and 24, respectively; this difference was statistically significant (P < 0.001). Their pre- and postoperative mean F0and speaking F0were 152 and 158 and 195 and 200 Hz, respectively; these differences were statistically significant (P < 0.001). Their pre- and postoperative acoustic analysis results were not significantly different (P > 0.05). Seven patients (26%) needed laser reduction glottoplasty for voice feminization because they were not satisfied with the voice result. Patients' self-evaluations of their postoperative voice revealed 20 feminine, 2 masculine, and 5 neither results, giving a rise to patient satisfaction rate of 74%. Medical students rated 85% of postoperative voice samples as feminine, giving rise to overall success rate of 85%.
  
  
  CONCLUSIONS
  Anterior commissure web formation is a successful surgical option for voice feminization. However, additional surgery may be necessary for patient satisfaction.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey. Electronic address: tyilmaz@hacettepe.edu.tr.
authors.forename: Taner
authors.initials: T
authors.lastname: Yılmaz
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Oğuz
authors.initials: O
authors.lastname: Kuşçu
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Tevfik
authors.initials: T
authors.lastname: Sözen
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors.forename: Ahmet Emre
authors.initials: AE
authors.lastname: Süslü
mesh_terms: D000162:Acoustics; D000293:Adolescent; D000328:Adult; D004185:Disability Evaluation; D005260:Female; D005262:Feminization; D005931:Glottis / Q000503:physiopathology / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007828:Laryngoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012086:Reoperation; D012649:Self Concept; D013061:Speech Acoustics; D013067:Speech Perception; D013068:Speech Production Measurement; D013997:Time Factors; D063106:Transgender Persons; D014189:Transsexualism / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000601:surgery*; D016896:Treatment Outcome; D014421:Turkey; D014833:Voice Quality; D055815:Young Adult
keywords: Feminization; Transgender persons; Transsexualism; Vocal cords; Voice