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Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension

  • Laryngology
  • Published:
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Abstract

To evaluate type IIIB thyroplasty using the excised larynx bench apparatus and determine how altering vocal fold contour by performing bilateral medialization of the inferior vocal fold affects phonation. This procedure could be performed in patients for whom pitch lowering is desirable, such as female-to-male transsexuals or male patients with mutational falsetto in whom intensive voice therapy was insufficient. Aerodynamic, acoustic, and high-speed videokymographic data were collected for nine larynges at three subglottal pressure inputs for each of three conditions: normal; type IIIB thyroplasty; and combined type IIIB with modified bilateral type I thyroplasty intended to create a more rectangular glottal configuration. Each larynx served as its own control. Phonation threshold flow (p = 0.005), phonation threshold power (p = 0.031), and airflow varied across conditions with highest values for type IIIB thyroplasty and lowest for the combined procedure. Fundamental frequency was significantly different (p < 0.001), decreasing by approximately 100 Hz from control to type IIIB trials, and then by approximately 15 Hz from IIIB to combined procedure trials. Vibratory amplitudes and intrafold phase difference were highest for type IIIB trials. Addition of bilateral inferior medialization to type IIIB thyroplasty provided some further decrease in frequency, but mostly served to increase tension, reduce airflow, and produce a vibratory pattern which more closely mirrored control trials. Exploration of this combined procedure in patients may be warranted if not completely satisfied with the results from type IIIB thyroplasty alone.

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Acknowledgments

This study was funded by National Institutes of Health Grant Numbers F31 DC012495 and R01 DC008153 from the National Institute on Deafness and other Communicative Disorders.

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Authors and Affiliations

  1. Division of Otolaryngology, Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, 1300 University Avenue, 2725 Medical Sciences Center, Madison, WI, 53706, USA

    Matthew R. Hoffman, Erin E. Devine, Charles N. Ford, Elizabeth Wadium & Jack J. Jiang

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Louvain University Hospital of Mont-Godinne, Yvoir, Belgium

    Marc Remacle

Authors
  1. Matthew R. Hoffman
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  2. Erin E. Devine
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  3. Marc Remacle
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  4. Charles N. Ford
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  5. Elizabeth Wadium
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  6. Jack J. Jiang
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Correspondence to Jack J. Jiang.

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Hoffman, M.R., Devine, E.E., Remacle, M. et al. Combined type IIIB with bilateral type I thyroplasty for pitch lowering with maintenance of vocal fold tension. Eur Arch Otorhinolaryngol 271, 1621–1629 (2014). https://doi.org/10.1007/s00405-013-2798-0

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  • DOI: https://doi.org/10.1007/s00405-013-2798-0

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