Feminization Laryngoplasty: 17-Year Review on Long-Term Outcomes, Safety, and Technique

Objectives Transfeminine patients can experience significant gender dysphoria in vocal communication. Feminization laryngoplasty (FL) is a gender-affirming surgery developed to elevate speaking vocal range, as well as alter vocal resonance and laryngeal cosmesis. The purpose here was to appraise FL’s long-term voice outcomes across a 17-year review period. Study Design Level III, retrospective study and description of technique. Setting A single-institution transfeminine voice clinic. Methods Voice data (speaking fundamental frequency [F0], lowest F0, highest F0, F0 range in both Hertz and semitones, and maximum phonation time [MPT]) were collected and assessed. Self-assessment of voice femininity and complications were documented. Results The 162 patients, all transfeminine women, had a mean age of 40 years with 36-month mean follow-up. There were significant increases in mean speaking F0 (Δ = 50 ± 30 Hz, Δ = 6 ± 3 semitones; P < .001) and mean change in lowest F0 (Δ = 58 ± 31 Hz, Δ = 8 ± 4 semitones; P < .001). There was no significant difference in mean change in highest F0 or MPT. There was significant improvement (Δ = 60% ± 39%; P < .001) in perceptual self-assessment of vocal femininity. There was a 1.2% rate of major postoperative complications requiring inpatient admission or operative intervention. There were no differences in vocal outcomes between those patients who had less than 1-year follow-up and those who had 5-year follow-up. Conclusion FL in this cohort was a safe and effective technique for increasing mean speaking F0, mean lowest F0, and voice gender perception over a prolonged follow-up period. These findings add to the possible treatments aimed at addressing the morbid dysphoria related to voice and communication for our transfeminine patients.

Associations Between Speaking Fundamental Frequency, Vowel Formant Frequencies, and Listener Perceptions of Speaker Gender and Vocal Femininity–Masculinity

Purpose The aim of the study was to examine associations between speaking fundamental frequency ( f os ), vowel formant frequencies ( F ), listener perceptions of speaker gender, and vocal femininity–masculinity. Method An exploratory study was undertaken to examine associations between f os , F 1 – F 3 , listener perceptions of speaker gender (nominal scale), and vocal femininity–masculinity (visual analog scale). For 379 speakers of Australian English aged 18–60 years, f os mode and F 1 – F 3 (12 monophthongs; total of 36 F s) were analyzed on a standard reading passage. Seventeen listeners rated speaker gender and vocal femininity–masculinity on randomized audio recordings of these speakers. Results Model building using principal component analysis suggested the 36 F s could be succinctly reduced to seven principal components (PCs). Generalized structural equation modeling (with the seven PCs of F and f os as predictors) suggested that only F 2 and f os predicted listener perceptions of speaker gender (male, female, unable to decide). However, listener perceptions of vocal femininity–masculinity behaved differently and were predicted by F 1 , F 3 , and the contrast between monophthongs at the extremities of the F 1 acoustic vowel space, in addition to F 2 and f os . Furthermore, listeners' perceptions of speaker gender also influenced ratings of vocal femininity–masculinity substantially. Conclusion Adjusted odds ratios highlighted the substantially larger contribution of F to listener perceptions of speaker gender and vocal femininity–masculinity relative to f os than has previously been reported.

Aerodynamic and Acoustic Voice Measures Before and After an Acute Public Speaking Stressor

Purpose The goal of this study was to determine if differences in stress system activation lead to changes in speaking fundamental frequency, average oral airflow, and estimated subglottal pressure before and after an acute, psychosocial stressor. Method Eighteen vocally healthy adult females experienced the Trier Social Stress Test (TSST) to activate the hypothalamic–pituitary–adrenal axis. The TSST includes public speaking and performing mental arithmetic in front of an audience. At seven time points, three before the stressor and four after the stressor, the participants produced /pa/ repetitions, read the Rainbow Passage, and provided a saliva sample. Measures included (a) salivary cortisol level, (b) oral airflow, (c) estimated subglottal pressure, and (d) speaking fundamental frequency from the second sentence of the Rainbow Passage. Results Ten of the 18 participants experienced a hypothalamic–pituitary–adrenal axis response to stress as indicated by a 2.5-nmol/L increase in salivary cortisol from before the TSST to after the TSST. Those who experienced a response to stress had a significantly higher speaking fundamental frequency before and immediately after the stressor than later after the stressor. No other variable varied significantly due to the stressor. Conclusions This study suggests that the idiosyncratic and inconsistent voice changes reported in the literature may be explained by differences in stress system activation. In addition, laryngeal aerodynamic measures appear resilient to changes due to acute stress. Further work is needed to examine the influence of other stress systems and if these findings hold for dysphonic individuals.

Age-Related Changes in Speech and Voice: Spectral and Cepstral Measures

Purpose This study examined differences in selected acoustic measures of speech and voice according to age and sex and across families. Method Participants included 169 individuals, 79 men and 90 women, from 18 families, ranging in age from 17 to 87 years. Participants reported no history of articulation disorders, stroke or active neurologic disease, or severe-to-profound hearing loss. They read aloud two passages to facilitate examination of the following speech and voice acoustic parameters: fricative spectral moments (center of gravity, standard deviation, skewness, and kurtosis), the proportion of time spent speaking, mean speaking fundamental frequency, semitone standard deviation (STSD), and cepstral peak prominence smoothed. Results The results indicated a significant age effect for fricative spectral center of gravity, spectral skewness, and speaking STSD. There was a significant sex effect for spectral center of gravity, spectral kurtosis, and mean fundamental frequency. Familial relationship was significant for spectral skewness, STSD, and cepstral peak prominence smoothed. Conclusions These findings revealed that certain speech and voice features change with age and some change differently for men and women. Additionally, speakers from the same family units may demonstrate similar patterns for prosody, voicing, and articulatory behavior. The results also demonstrated normal differences in speech and voice variation across age, sex, and family unit. Understanding patterns and differences across these demographic variables in healthy speakers is important to distinguishing more confidently between normal and disordered speech and voice patterns clinically.

Pitch Range in the Production of Saudi and English Women

<p><span style="font-size: medium;">In the present small-scale preliminary study, we sampled four groups of younger and older female Arabic and English speakers to examine if speaking fundamental frequency (SFF) could show any systematic variations across languages and different age groups performing different tasks. All groups of speakers were recorded reading the North Wind and the Sun twice in their native language, and speaking spontaneously about themselves for around two minutes. Mean SFF values for each speaker and speaking task were obtained using Praat’s autocorrelation algorithm with a pitch range of 100-500Hz, with manual correction to remove spurious F0 values caused by doubling or halving the first harmonic. As well as presenting SFF results for all groups, mean values will be given for each group and speaking task. </span></p>