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 (F0), 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 F0 improved after surgery for both groups, but this increase was 27 Hz higher after GL than after CTA (P < 0.05). After CTA, F0 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 F0, improving QoL in MtF Ts. However, F0 increase is higher and more long‐lasting after GL. More risk of postoperative roughness is described after GL. Level of Evidence 4. Laryngoscope, 128:2101–2109, 2018