Study on Voice Surgery

Prof. Somyos Kunachak, a renowned Plastic and Cosmetic Surgeon in Thailand and an ENT specialist, together with his colleagues, launched a study regarding Voice Surgery.

The study was conducted between 1990-1996 where 6 male-to-female transexual patients were enrolled, between ages 20-27. All subjects in the study had undergone complete physical and psychological evaluation before entering the research. Five (5) of the subjects had already undergone sexual reassignment surgery, while all had been using estrogen and progesterone hormones for years prior to the study.

The subjects generally appear masculine with their anterior thyroid cartilage prominence (Adam's Apple) high and pointed, as typical for men. Their internal laryngeal structure were particularly false and the true vocal cords were voluminous and masculine, with their voices male-like despite the their voluntary female voice imitation.

Objective voice assessment included pre and post-operative tape recording, spectography, macximum phonation time, and determination of fundamental frequency, jitter and shimmer using VISIPITCH M 3300 (USA).

All subjects passed a psychiatric evaluation before being asked to sign for consent.

The surgical procedure was done under general anesthesia with a 4-6cm transverse cervical incision halfway between the superion thyroid notch and the inferior borded of the thyroid cartilage. None of the subjects experience any complication during the surgery.

After the procedure, the subjects rested their for the first 2 weeks, and follow up was made every 2 weeks for the first month, then every month. Two (2) of the subjects developed granulation tissue at the anterior commissure between the 1st and 2nd month after surgery. The issue was successfully addressed by 1 session of carbon dioxide laser vaporization via microlaryngoscopic approach.

Subjectively, all subjects were satisfied with the result of their voice surgery. One of the subjects had to go back to his country while another one just stopped coming for follow up between the 5th to the 12th month. During the last follow up when the subjects were still complete, their voices sound closer to the feminine voice. The subjecte had maintaned a female range of vocal pitch after their 2-6 year follow up.