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Ismail Kocak, MD, MSc; Muzeyyen Dogan, MD; Elcin Tadihan, MSc; Zeynep Alkan Cakir, MD; Serkan Bengisu, MSc; Meltem Akpinar, MD

Arch Otolaryngol Head Neck Surg. 2008;134(12):1263-1269.

Objective  To present the success rate of a less invasive modification of Isshiki type III anterior commissure relaxation laryngoplasty technique in patients with high-pitched voice disorders.

Design  Prospective case series.

Setting  KBB Major Private Clinic of Istanbul Surgery Hospital and the University of Yeditepe Hospital.

Patients  Twenty-one adult patients who believed that their high-pitched voices conflicted with their body image and/or gender identity.

Intervention  Type III thyroplasty for pitch alteration.

Main Outcome Measures  Comparison of preoperative and postoperative (>6 months) fundamental frequency levels, diplophonia, perception of body image and pitch, and subjective ratings of comfort during vocalization.

Results  The patients were mostly male (mean age, 30.5 years). The most frequent cause of high-pitched voice was sulcus vocalis (n = 14), followed by constitutional causes (n = 5), mutational falsetto (n = 1), and severe glottic scarring secondary to childhood diphtheria (n = 1). After surgery, the fundamental frequency dropped significantly from a mean of 213.81 Hz to 149.86 Hz (P < .001), equaling a mean postoperative semitone drop of 6.23. Misperception leading to an abnormal body image was reduced by 86%. Fourteen patients who originally had feelings of tension and fatigue during phonation and vocalization gained comfort postoperatively. Diplophonia with subharmonic signals observed in 11 cases preoperatively was reduced or disappeared in 6 cases. No complications or failures were observed during the follow-up period.

Conclusion  Window anterior commissure relaxation laryngoplasty is an efficient, easy, less invasive, and safe procedure in the surgical management of organic and functional high-pitched voice disorders.

Author Affiliations: Department of Otorhinolaryngology, Head and Neck Surgery, School of Medicine, Yeditepe University, (Drs Kocak and Dogan and Ms Tadihan); Second Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul Education and Research Hospital (Dr Alkan Cakir); and KBB Major Private Clinic, Department of Otorhinolaryngology, Head and Neck Surgery, Istanbul Surgery Hospital (Mr Bengisu and Dr Akpinar), Istanbul, Turkey.

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