Cricothyroid Approximation or Glottoplasty, which surgery is right for me?

One of the questions I am often asked during my first interaction with patients is around which surgery is the right option for them. In this post I will talk about the different procedures available and how to make an informed decision.

For some gender diverse individuals, voice can be the source of considerable dysphoria. While speech therapy plays a vital role in creating a voice which more accurately reflects who we are, for some, therapy alone does not achieve the result they are looking for. This is where voice feminisation surgery can help. 

The two main options when it comes to voice feminisation surgery are Cricothyroid Approximation and Glottoplasty.

Cricothyroid Approximation used to be the standard procedure for anyone looking to increase the pitch of their voice. The process involves making an incision in the skin on the neck and then bringing together the cricoid and the thyroid cartilages of the voice box to increase the tension of the vocal cords, like tightening the strings of a guitar. 

Over recent years there has been significant progress made in the field of voice feminisation surgery including the introduction of a new, minimally invasive procedure known as Glottoplasty – or to be precise the modified Wendler Glottoplasty technique. This procedure involves shortening the vibrating segment of the vocal cord by around 40 percent by stitching the front of the vocal cords together, in order to raise the pitch. 

We access the vocal cords via the mouth, so there are no skin incisions and the recovery time is faster. Glottoplasty results in a more natural sounding voice, like the original but higher. Because of the consistent results, Glottoplasty has become the most effective and most predictable procedure for voice feminisation. We will still consider Cricothyroid Approximation as a second option, in the event that there is not sufficient pitch increase with Glottoplasty, but Glottoplasty is the preferred method.

People often ask about the levels of pain associated with the various procedures. Both operations are carried out under general anesthetic, so you won’t feel anything during the operation. Once the anaesthetic wears off there will be limited discomfort but we prescribe co-codamol, which contains codeine and paracetamol, to ease any pain. The codeine helps to suppress coughing and the paracetamol is normally more than enough to help with any pain from the surgery. Glottoplasty is a less invasive procedure and as such, there are fewer after effects.

Following either procedure full voice rest is indicated for a week. You can then begin to introduce a couple of words at a time in week two and increase voice use gradually up to week  five. By week six you should have near normal use of your voice and while some individuals may be able to hear the full effects of their surgery sooner, it can take up to four months before your voice finally settles and you have a good idea of how your post-operative voice will sound.