Effect of Wendler glottoplasty on voice and quality of life of transgender women

Abstract Objective: To investigate the effect of Wendler glottoplasty on voice feminization, voice quality and voice-related quality of life. Methods: Prospective interventional cohort of transgender women submitted to Wendler glottoplasty. Acoustic analysis of the voice included assessment of fundamental frequency, maximum phonation time formant frequencies (F1 and F2), frequency range, jitter and shimmer. Voice quality was blindly assessed through GRBAS scale. Voice-related quality of life was measured using the Trans Woman Voice Questionnaire and the self-perceived femininity of the voice. Results: A total of 7 patients were included. The mean age was 35.4 years, and the mean postoperative follow-up time was 13.7 months. There was a mean increase of 47.9 ± 46.6 Hz (p = 0.023) in sustained/e/F0 and a mean increase of 24.6 ± 27.5 Hz (p = 0.029) in speaking F0 after glottoplasty. There was no statistical significance in the pre- and postoperative comparison of maximum phonation time, formant frequencies, frequency range, jitter, shimmer, and grade, roughness, breathiness, asthenia, and strain scale. Trans Woman Voice Questionnaire decreased following surgery from 98.3 ± 9.2 to 54.1 ± 25.0 (p = 0.007) and mean self-perceived femininity of the voice increased from 2.8 ± 1.8 to 7.7 ± 2.4 (p = 0.008). One patient (14%) presented a postoperative granuloma and there was 1 (14%) premature suture dehiscence. Conclusion: Glottoplasty is safe and effective for feminizing the voice of transgender women. There was an increase in fundamental frequency, without aggravating other acoustic parameters or voice quality. Voice-related quality of life improved after surgery.

摘要 目的：探讨温德勒声带成形术（Wendler glottoplasty）对跨性别女性嗓音女性化、嗓音质量及嗓音相关生活质量的影响。方法：纳入接受该术式的跨性别女性，采用前瞻性干预队列研究设计。嗓音声学分析涵盖基频、最长发声时间、共振峰频率（F1、F2）、音域、基频微扰（jitter）与振幅微扰（shimmer）。采用盲法通过GRBAS量表评估嗓音质量；采用跨性别女性嗓音问卷（Trans Woman Voice Questionnaire）及嗓音自我感知女性化程度评估嗓音相关生活质量。结果：共纳入7例患者，平均年龄35.4岁，术后平均随访时长13.7个月。术后持续发/e/音的基频平均升高47.9±46.6 Hz（p=0.023），讲话基频平均升高24.6±27.5 Hz（p=0.029）。最长发声时间、共振峰频率、音域、基频微扰、振幅微扰及GRBAS量表评分的术前术后比较均无统计学差异。术后跨性别女性嗓音问卷评分较术前的98.3±9.2降至54.1±25.0（p=0.007），嗓音自我感知女性化程度平均从2.8±1.8升至7.7±2.4（p=0.008）。1例患者（14%）术后出现肉芽肿，1例（14%）发生缝线过早开裂。结论：温德勒声带成形术用于跨性别女性嗓音女性化安全有效。患者基频升高，未加重其他声学参数或嗓音质量，术后嗓音相关生活质量得到改善。