Comparison of Cricothyroid Approximation and Glottoplasty for Surgical Voice Feminization in Male-to-Female Transsexuals

Objective: To compare voice feminization and quality of life (QoL) of Male-to-Female Transsexuals (MtF Ts) after cricothyroid approximation (CTA) or glottoplasty (GL). Study Design: Retrospective study. Methods: Fifty-three MtF Ts were studied between 2007 and 2016. Voice assessment was based on fundamental frequency (F-0), perceptual rating on GBRAS Hirano scale (Grade, Breathiness, Roughness, Asthenia, Strain), QoL related to voice on the Voice Handicap Index-10 Spanish validated version (VHI-10 Sv) and self-perceived femininity of the voice (SpFv), and overall satisfaction with the surgical technique (Sst) on a visual analogue scale (VAS). Demographic data and complications related to surgery were also recorded. Results: Twenty-eight MtF Ts underwent CTA and 23 GL. The mean age was 35 years. The median follow-up period was 40 months. Mean F-0 improved after surgery for both groups, but this increase was 27Hz higher after GL than after CTA (P<0.05). After CTA, F-0 decreased over time but remained stable after GL. The GBRAS score did not change after CTA; the roughness item and total score increased from 0 to 1 after GL (P<0.05). VHI-10 Sv scores decreased similarly in both groups. SpFv increase was higher after GL. The Sst was mild and similar in both groups. One case of severe dysphonia (4%) resulting from a big and fibrous sinequia occurred after GL. Conclusion: Both CTA and GL increase F-0, improving QoL in MtF Ts. However, F-0 increase is higher and more long-lasting after GL. More risk of postoperative roughness is described after GL.