Anterior Glottic Web Formation for Voice Feminization: Experience of 27 Patients

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.

This is a nonrandomized prospective cohort study.

University hospital.

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 F₀ were determined pre- and postoperatively. Patients and medical students rated pre- and postoperative voices as feminine, masculine, or neither.

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 F₀ and speaking F₀ were 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%.

Anterior commissure web formation is a successful surgical option for voice feminization. However, additional surgery may be necessary for patient satisfaction.