Beyond Group Outcomes: Gender-Affirming Glottoplasty and Postoperative Voice Therapy.

Abstract

To describe outcomes of gender-affirming glottoplasty with adjunctive voice therapy in trans women and explore relationships between acoustic and patient-reported measures of voice. A prospective, descriptive and exploratory study included 58 trans women undergoing glottoplasty performed and followed in a single multidisciplinary voice clinic. Acoustic outcomes included speaking fundamental frequency (sf_o), min and max sf_o, phonation range, and spectral measures derived from sustained vowels and connected speech. Patient-reported outcomes included the TWVQ and voice satisfaction measures. Associations between acoustic and patient-reported measures were analyzed. A linear mixed-effects model (LMM) was used to estimate the group-level intervention effect in addition to covariates age and number of prior and postoperative voice therapy sessions. Glottoplasty was associated with group-level increases in sf_o but substantial interindividual variability in acoustic and functional outcomes. LMM showed substantial pre- to post-intervention increase in sf_o, min and max sf_o, max f_o, and improvement in TWVQ scores but deterioration in AVQI, CPPS, and in phonation range. Age and number of pre- or postoperative voice therapy sessions had no substantial effect on outcomes. Patient-reported measures indicated improvement in perceived voice outcomes, but associations between acoustic measures and patient-reported outcomes were variable. Gender-affirming glottoplasty with adjunctive postsurgical voice therapy results in improved key acoustic and patient-reported voice outcomes at a group level; however, outcomes vary between individuals. These findings highlight the multifactorial nature of voice change following glottoplasty and the importance of multidimensional assessment beyond fundamental frequency, given outcomes reflect more than structural vocal fold shortening.