Research Article| Volume 27, ISSUE 5, P650-654, September 2013

Type 3 Thyroplasty for Patients With Mutational Dysphonia



      The cases consisted of three men with mutational dysphonia, who were aged 37, 35, and 38 years. The speaking fundamental frequencies (SFFs) at the time of the initial diagnosis were 174.6, 170.2, and 180.0 Hz.


      In all three patients, voice therapy proved ineffective; therefore, surgery was considered. In the anterior-posterior compression test performed preoperatively in the three patients, the voice became low-pitched.


      The SFFs decreased postoperatively to 106.9, 115.4, and 87.5 Hz, respectively, in the three patients.


      Type 3 thyroplasty (TP3) is effective for the treatment of patients with mutational dysphonia in whom voice therapy proved unsuccessful.


      The SFF of men is high in childhood. At the time of the second pubescent sexual orientation, the frequency usually decreases. However, in some cases, the high-pitched voice of childhood may persist without successful switch to a low-pitched voice during puberty. Thus, there are rare cases of adults with a high-pitched boyish voice. Voice therapy is usually effective for the treatment; however, it may fail in some cases. We performed TP3 for subjects in whom voice therapy proved ineffective. With TP3, the tension of the vocal folds decreases, and the voice becomes low-pitched.

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        • Dagli M.
        • Sati I.
        • Acar A.
        • Stone R.E.
        • Dursun G.
        • Eryilmaz A.
        Mutational falsetto: intervention outcomes in 45 patients.
        J Laryngol Otol. 2008; 122: 277-281
        • Lim J.Y.
        • Lim S.E.
        • Choi S.H.
        • Kim J.H.
        • Kim K.M.
        • Choi H.S.
        Clinical characteristics and voice analysis of patients with mutational dysphonia: clinical significance of diplophonia and closed quotients.
        J Voice. 2007; 21: 12-19
        • Isshiki N.
        • Morita H.
        • Okumura H.
        • Hiramoto M.
        Thyroplasty as a new phonosurgical technique.
        Acta Otolaryngol. 1974; 78: 451-457
        • Isshiki N.
        • Taira T.
        • Tanabe M.
        Surgical alternation of the vocal pitch.
        J Otolaryngol. 1983; 12: 335-340
        • Slavit D.H.
        • Maragos N.E.
        • Lipton R.J.
        Physiologic assessment of Isshiki type 3 thyroplasty.
        Laryngoscope. 1990; 100: 844-848
        • Li G.D.
        • Mu L.
        • Yang S.
        Acoustic evaluation of Isshiki type 3 thyroplasty for treatment of mutational voice disorders.
        J Laryngol Otol. 1999; 113: 31-34
        • Remacle M.
        • Matar N.
        • Verduyckt I.
        • Lawson G.
        Relaxation thyroplasty for mutational falsetto treatment.
        Ann Otol Rhinol Laryngol. 2010; 119: 105-109
        • Nakamura K.
        • Muto T.
        • Yoshida T.
        • Hiramatsu H.
        • Watanabe Y.
        • Suzuki M.
        Efficacy of total intravenous anesthesia without intubation for laryngeal framework surgery.
        Acta Otolaryngol. 2008; 128: 1037-1042
        • Isshiki N.
        • Tanabe M.
        • Ishizaka K.
        • Broad D.
        Clinical significance of asymmetrical vocal cord tension.
        Ann Otol Rhinol Laryngol. 1977; 86: 58-66
        • Isshiki N.
        • Haji T.
        • Yamamoto Y.
        • Mahieu H.F.
        Thyroplasty for adductor spasmodic dysphonia: further experiences.
        Laryngoscope. 2001; 111: 615-621
        • Kocak I.
        • Dogan M.
        • Tadiham E.
        • Cakir Z.A.
        • Bengisu S.
        • Akpinar M.
        Window anterior commissure relaxation laryngoplasty in the management of high-pitched voice disorders.
        Arch Otolaryngol. 2008; 134: 1263-1269
        • Pau H.
        • Murty G.E.
        First case of surgically corrected puberphonia.
        J Laryngol Otol. 2001; 115: 60-61
        • Woodson G.E.
        • Murry T.
        Botulinum toxin in the treatment of recalcitrant mutational dysphonia.
        J Voice. 1994; 8: 347-351
        • Sanuki T.
        • Isshiki N.
        Overall evaluation of effectiveness of type II thyroplasty for adductor spasmodic dysphonia.
        Laryngoscope. 2007; 117: 2255-2259
        • Nakamura K.
        • Muta H.
        • Watanabe Y.
        • Mochizuki R.
        • Yoshida T.
        • Suzuki M.
        Surgical treatment for adductor spasmodic dysphonia—efficacy of bilateral thyroarytenoid myectomy under microlaryngoscopy.
        Acta Otolaryngol. 2008; 128: 1348-1353
        • Vaidya S.
        • Vyas G.
        Puberphonia: a novel approach to treatment.
        Indian J Otolaryngol Head Neck Surg. 2006; 58: 20-21