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Effect of Endoscopic Glottoplasty on Acoustic Measures and Quality of Voice: A Systematic Review and Meta-Analysis

  • Mateus Morais Aires
    Correspondence
    Address correspondence and reprint requests to Mateus M. Aires, Department of Otolaryngology, Universidade Federal de São Paulo – Rua Botucatu 740, 04023-062 – São Paulo, São Paulo, Brazil.
    Affiliations
    Department of Otolaryngology–Head and Neck Surgery of Hospital das Clínicas da Universidade Federal de Pernambuco – Av. Prof. Moraes Rego 1235, Pernambuco, Brazil
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  • Camila Barbosa Marinho
    Affiliations
    Department of Otolaryngology–Head and Neck Surgery of Hospital das Clínicas da Universidade Federal de Pernambuco – Av. Prof. Moraes Rego 1235, Pernambuco, Brazil
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  • Camila de Santa Cruz Souza
    Affiliations
    Department of Otolaryngology–Head and Neck Surgery of Hospital das Clínicas da Universidade Federal de Pernambuco – Av. Prof. Moraes Rego 1235, Pernambuco, Brazil
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Published:December 01, 2020DOI:https://doi.org/10.1016/j.jvoice.2020.11.005

      Summary

      Introduction

      The voice is an important marker of the transition process to the new gender identity of the transgender person. For 20% of patients seeking voice feminization, voice therapy is not completely satisfactory, and surgery should be considered, with endoscopic glottoplasty being the current practice. While the increase in fundamental frequency (F0) after glottoplasty has been well described, no systematic review of the literature or meta-analysis regarding other acoustic parameters and quality of voice has been performed yet.

      Objective

      To define the effect of endoscopic glottoplasty on acoustic measures and quality of voice by assessing F0, maximum phonation time (MPT), frequency range, and grade of dysphonia.

      Methods

      A literature review was performed in Medline/PubMed, Cochrane, Science Direct, LILACS, and Google Scholar, following PRISMA guidelines, with no constraints on publication date. We included studies in English, Portuguese or Spanish that assessed transgender women who underwent endoscopic glottoplasty. All the included articles were measured in terms of their methodological quality.

      Results

      The PRISMA approach yielded 14 studies, totaling 566 patients. There was significant heterogeneity between studies regarding follow-up time, surgical technique and perioperative care. Thirteen studies were submitted to meta-analysis. The results showed significant changes in pre- to postglottoplasty mean differences of F0 = 78.49 Hz (95%CI: 75.69–81.30), MPT = −1.11 seconds (95%CI −1.67 to −0.54), frequency range = −3.55 semitones (95%CI −5.74 to −1.36) and grade of dysphonia on the GRBAS scale = 0.44 (95%CI 0.27–0.61).

      Conclusion

      Glottoplasty is effective in significantly increasing fundamental frequency, but slightly decreases MPT, frequency range and vocal quality measured by the grade of dysphonia on the GRBAS scale.

      Key Words

      Abbreviations:

      VT (voice therapy), F0 (fundamental frequency), F1 (first formant), F2 (second formant), Hz (Hertz), VF (vocal fold), MPT (maximum phonation time), SD (standard deviation), CI (confidence interval), NOS (Newcastle-Ottawa Quality Assessment Adjusted Scale: Cohort Studies), VHI (Voice Handicap Index), TSEQ (Transgender Self-Evaluation Questionnaire), VAS (visual analog scale), PROM (patient-reported outcome measure), TVQMtF (Transgender Voice Questionnaire for Male-to-Female Transsexuals), NS (not stated or not extractable), IV (inverse variance)
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