A resource for speech pathologists
 Laryngeal Surgery
The overall aim of laryngeal surgery for male-to-female clients is to raise fundamental frequency to a level that is perceived as female.9 Various methods can be used to achieve this increase in pitch, with the most common techniques performed being crico-thyroid approximation and anterior commissure advancement.
Crico-thyroid approximation
This procedure pulls the cricoid and thyroid cartilages of the larynx closer together in a fixed position, thereby stretching the vocal folds resulting in an increase in fundamental frequency.39
Anterior commissure advancement
Under this procedure, a section of the thyroid cartilage centred on the anterior commissure is surgically advanced and held in position.39 This tightens the vocal folds and results in a higher fundamental frequency.39
The benefits of laryngeal surgery are open to discussion. While some studies have shown an increase in mean fundamental frequency,7, 26, 39 there has been variability between subjects.7 In certain studies, clients have demonstrated no change or even reductions in mean fundamental frequency.39 More research is required before conclusions can be made about outcomes of surgery and all clients should be fully informed of the risks, side-effects and variability in surgery outcomes before making decisions regarding surgery.13
Pitch-raising surgery is generally considered if the client is dissatisfied with gains made in voice therapy, however clients should be aware that the surgery may not produce the desired results. Often additional voice therapy will be required post-surgery.17
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