Speaking fundamental frequency and Voice Handicap Index subscales after cricothyroid approximation in transgender women: A retrospective cohort study.

Abstract

Objective: This study aimed to evaluate the speaking fundamental frequency (SFF) and Voice Handicap Index-30 (VHI-30) scores, including physical, functional, and emotional subscales in transgender women undergoing cricothyroid approximation (CTA) under local anesthesia.

Methods: In this single-center, retrospective study, we enrolled 14 transgender women who underwent CTA between April 2019 and March 2024. All surgeries were performed under local anesthesia, with intraoperative voice monitoring. The SFF and VHI-30 scores were assessed preoperatively and at 3 months postoperatively. Data were expressed as medians and interquartile ranges [IQR; 25th-75th percentiles]. Statistical comparative analysis was performed using the Wilcoxon signed-rank test.

Results: The SFF values significantly increased from 145.5 Hz [123.8-163.8] preoperatively to 212 Hz [206.5-231.3] postoperatively (P < 0.05). The total VHI-30 score decreased significantly from 62.5 [45.5-84.0] to 32 [15.3-59.8] (P < 0.05). Subscale analysis revealed significant improvements in the functional (21 [12.8-33.8] to 10.5 [8.0-19.8]) and emotional subscales (25 [18.3-30.8] to 8.5 [1.3-21.0]) (P < 0.05). However, no significant changes were observed in the physical subscale (15.5 [8.0-21.3] to 12 [7.3-18.5]; P = 0.14).

Conclusion: CTA under local anesthesia significantly improved SFF and ameliorated voice-related distress, particularly in the functional and emotional subscales, whereas no significant changes were observed in the physical subscale. These findings underscore the utility of VHI-30 subscale analysis in identifying patient-specific concerns and support the development of personalized and gender-affirming voice interventions in transgender women.