Male to female vocal surgery - Feminization laryngoplasty: Case 4

This surgery removes the anterior portion of the voice box (thyroid cartilage) and shortens the vocal cords before putting the voice box back together. I have added in this iteration of the surgery, the suspension of the larynx from the hyoid as well. I have been calling the procedure FemLar, short for the Femininization Laryngoplasty.

These recordings are set to a fairly low resolution for the internet but do demonstrate the general sound and function of the vocal cords before and after this case of laryngeal reduction surgery. Much more detail is actually visible in the office. The videos when shown are oriented with the front down and the left vocal fold is on the right of the video. Orientation is discussed here. Please note: These examples of possible results should not be construed to represent what will be acheived in any other patient.

Pre Surgery

6 weeks

6 months

Reading passage

Pitch is described relative to C4 or middle C on the piano.

Pitch: about D3

(typical male speaking range about B2 - E3)

Pitch: about G3 (about 5 semitones higher than pre-op)

(normal female speaking range about E3 - A3)

Pitch: G3 (about 5 semitones higher than pre-op)

(normal female speaking range about E3 - A3)

Lowest pitch

Pitch: about E2 (normal male low range varies C1 - C3)

Pitch: about D3# (normal female low range varies between B2 - F3) this is a glide from high to lowest pitch. It is nearly an octave higher at this point.

Pitch: F3

Highest pitch

Pitch: about C5

Pitch: about D5 - this is a glide from low to the highest pitch.

Pitch: reaches B4, diplophonic at the high end

Vegetative sounds

coughing & throat clearing

Pitch:

There is a slight female quality to the throat clearing

Pitch: Perhaps a slight change.

Yell

loud phonation

A little rough quality

Seemingly a higher pitch.

Laryngoscopy

Views during respiration to get a close up view.

Stroboscopy

saying the sound /i/

Spectrogram

Running speech

Compared with my previous attempt at FemLar, I added a hyoid suspension procedure to the main procedure of a reduction in size of the voicebox. Thus, this was an attempt to shorten and tension the vocal cords with an addition: raising the larynx in the neck in an attempt to shorten the resonance chamber. Though the phaynx height is only one dimension for one of several chambers that constitute or create a male resonance, it is at least one chamber that can possibly be altered.

In the immediate post-operative period (first several weeks) her pitch was lower than pre-operatively. Even the day after surgery, the vocal cords were very edematous on exam and while discouraging to the patient, I think given the amount of surgery, this can likely be expected. There was a gradual change over the first six weeks with the pitch gradually rising. At the 6 week postoperative check, she notes that with only a small effort, she can place her pitch where she wants, as opposed to previously where it took a great deal of effort to keep the speaking pitch elevated.

At six months, I remain quite pleased with the quality of the speaking voice -really about as ideal as I could hope for as a surgeon. I am not as pleased as the asymmetry in tension of the cords that is evident at the high pitches. It is a relief that she is not a singer.

May 6 2004: "A speaking pitch of G3 (approx 200Hz) is exactly where I wanted the FemLar procedure to place me. Amazingly, Dr. Thomas has hit the nail on the head, and after 6 weeks, I am very satisfied with my progress. The only negative is a slight drop in volume and some quality, as the day progresses, but it's getting stronger and clearer day by day. I am falling in love with this voice!"