madman
Super Moderator
SUMMARY
Introduction: Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in male-to-female transsexual patients with gender dysphoria. On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures.
Case report: We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization, which impacted her self-esteem and quality of life (QOL). Voice feminization surgery using Wendler glottoplasty was performed with significant improvement in F0 and QOL.
Discussions: Sex hormones have a profound impact on the voice. Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments, which leads to a drop in F0. However, women who present androphonia rarely require surgical management and improve with vocal therapy alone. Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature. Our patient presented with severe masculinization of her voice with an F0 lower than the average adolescent male, which led to the requirement of surgical management.
Conclusions: Patients with severe androphonia that significantly affect their QOL and show no improvement after the management of the underlying pathology and intense vocal therapy are candidates for voice feminization surgeries. These procedures offer positive results both in terms of F0 and in improving patient’s self-esteem and QOL.
INTRODUCTION
Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in maleto-female transsexual patients with gender dysphoria.1 On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures.1 Adrenal cortical tumors that produce testosterone are rare.2 Elevated levels of androgens in females produce morphologic changes in the vocal folds that are irreversible even after removing the source.2 We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization which impacted her self-esteem and quality of life (QOL).
DISCUSSION
Sex hormones have a profound impact on the voice.3 Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments which leads to a drop in F0. 4,5 Polycystic ovarian syndrome is the most common cause of androphonia; however, usually, no surgical treatment is required and patients improve with vocal therapy alone.6-8 Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature.9,10 To our knowledge, this is the first report of a pitch-raising surgical procedure performed on a female patient with undesired masculinization of her voice in Latin America.
TheF0 required for a voice to be perceived as “female” is debated and very controversial. However, most laryngologist agree that a typical F0 for women is on the order of 210 Hz.11 Our patient presented severe masculinization of her voice with an F0 lower than the average adolescent male; 134 Hz.5 The decision to perform a voice feminization surgery was made after failure to improve with the removal of the tumor and after extensive vocal therapy. Wendler glottoplasty was chosen as it has been reported to produce the greatest increase in F0 out of the different pitch-raising surgical techniques described.1 The patient did not have prominent thyroid cartilage, and no reduction of Adam’s apple was required. Follow up showed no dehiscence of the sutures and long term follow-up showed an increase in F0 from 134 Hz to 268 Hz, which stabilized at 201 Hz after three and a half years.
CONCLUSION
In the management of adolescent female patients with virializing pathologies, early diagnosis is critical since it is known that intervention on the hormonal cycle prior to puberty reduces voice changes. However, in cases where virilization is already present, it is known that these changes are not reversible.5 When the F0 is clearly masculine and does not fit into the ambiguous pitch range, and when it importantly affects the quality of life, voice feminization surgeries can be considered as a viable option that achieves positive results both in terms of F0 and in improving a patient’s self-esteem and QOL. Vocal therapy should always be the first line of treatment and surgery should only be considered if adequate results are not achieved. If surgical management is chosen, postoperative vocal rest is critical for surgical success to avoid suture rupture. Granuloma formation over the sutures can be expected, but it tends to disappear in the first month after the surgery. We also recommend the patient continues with vocal therapy in the postoperative period. To our knowledge, this is the first report of a pitch-raising surgical procedure performed on a female patient with undesired masculinization of her voice. Further investigation into this topic is required.
Introduction: Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in male-to-female transsexual patients with gender dysphoria. On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures.
Case report: We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization, which impacted her self-esteem and quality of life (QOL). Voice feminization surgery using Wendler glottoplasty was performed with significant improvement in F0 and QOL.
Discussions: Sex hormones have a profound impact on the voice. Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments, which leads to a drop in F0. However, women who present androphonia rarely require surgical management and improve with vocal therapy alone. Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature. Our patient presented with severe masculinization of her voice with an F0 lower than the average adolescent male, which led to the requirement of surgical management.
Conclusions: Patients with severe androphonia that significantly affect their QOL and show no improvement after the management of the underlying pathology and intense vocal therapy are candidates for voice feminization surgeries. These procedures offer positive results both in terms of F0 and in improving patient’s self-esteem and QOL.
INTRODUCTION
Wendler glottoplasty is a voice feminization surgical procedure designed to increase the fundamental frequency (F0) in maleto-female transsexual patients with gender dysphoria.1 On average, Wendler glottoplasty has the most significant effect on F0 among voice feminization surgical procedures.1 Adrenal cortical tumors that produce testosterone are rare.2 Elevated levels of androgens in females produce morphologic changes in the vocal folds that are irreversible even after removing the source.2 We present the case of a young female patient with a testosterone-producing adrenocortical adenoma who underwent irreversible vocal changes secondary to virilization which impacted her self-esteem and quality of life (QOL).
DISCUSSION
Sex hormones have a profound impact on the voice.3 Increased testosterone and dihydrotestosterone are known to cause hypertrophy of the laryngeal muscles and ligaments which leads to a drop in F0. 4,5 Polycystic ovarian syndrome is the most common cause of androphonia; however, usually, no surgical treatment is required and patients improve with vocal therapy alone.6-8 Few cases of voice feminization procedures for the treatment of androphonia have been described in the literature.9,10 To our knowledge, this is the first report of a pitch-raising surgical procedure performed on a female patient with undesired masculinization of her voice in Latin America.
TheF0 required for a voice to be perceived as “female” is debated and very controversial. However, most laryngologist agree that a typical F0 for women is on the order of 210 Hz.11 Our patient presented severe masculinization of her voice with an F0 lower than the average adolescent male; 134 Hz.5 The decision to perform a voice feminization surgery was made after failure to improve with the removal of the tumor and after extensive vocal therapy. Wendler glottoplasty was chosen as it has been reported to produce the greatest increase in F0 out of the different pitch-raising surgical techniques described.1 The patient did not have prominent thyroid cartilage, and no reduction of Adam’s apple was required. Follow up showed no dehiscence of the sutures and long term follow-up showed an increase in F0 from 134 Hz to 268 Hz, which stabilized at 201 Hz after three and a half years.
CONCLUSION
In the management of adolescent female patients with virializing pathologies, early diagnosis is critical since it is known that intervention on the hormonal cycle prior to puberty reduces voice changes. However, in cases where virilization is already present, it is known that these changes are not reversible.5 When the F0 is clearly masculine and does not fit into the ambiguous pitch range, and when it importantly affects the quality of life, voice feminization surgeries can be considered as a viable option that achieves positive results both in terms of F0 and in improving a patient’s self-esteem and QOL. Vocal therapy should always be the first line of treatment and surgery should only be considered if adequate results are not achieved. If surgical management is chosen, postoperative vocal rest is critical for surgical success to avoid suture rupture. Granuloma formation over the sutures can be expected, but it tends to disappear in the first month after the surgery. We also recommend the patient continues with vocal therapy in the postoperative period. To our knowledge, this is the first report of a pitch-raising surgical procedure performed on a female patient with undesired masculinization of her voice. Further investigation into this topic is required.
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