Cricothyroid Approximation in Trans Women With Type A Cricothyroid Joints

Area of Science:

• Otolaryngology
• Speech and Language Pathology
• Gender-affirming care

Background:

• Low vocal pitch is a common concern for transgender women.
• Cricothyroid approximation (CTA) is a surgical procedure to increase vocal fundamental frequency.
• The efficacy and long-term stability of CTA in transgender women with specific laryngeal anatomy are not fully established.

Purpose of the Study:

• To evaluate the voice outcomes of cricothyroid approximation (CTA) in transgender women with Type A cricothyroid joints (CTJs).
• To assess the stability of voice pitch changes over a 5-year period following CTA.
• To determine the impact of CTA on patient-reported voice quality.

Main Methods:

• Prospective cohort study involving 35 transgender women with Type A CTJs, confirmed by computed tomography.
• Voice assessments included mean speaking level (MSL), loudness, vocal range, and the Trans Women Voice Questionnaire (TWVQ).
• Assessments were conducted pre- and post-voice therapy, and at multiple intervals up to 5 years after CTA.

Main Results:

• Voice therapy increased MSL from 134 Hz to 150 Hz.
• CTA significantly increased MSL to 184 Hz at 4 weeks and 199 Hz at 6 months postoperatively.
• MSL remained stable between 203-209 Hz for 5 years. TWVQ scores improved post-CTA and remained stable.

Conclusions:

• CTA is a valuable and effective surgical technique for elevating vocal pitch in transgender women with Type A CTJs.
• The voice pitch improvements achieved with CTA are stable for at least 5 years.
• CTA should be considered for transgender women with Type A CTJs seeking voice feminization.