Case 8 (2004) 56 yo

This surgery removes the anterior portion of the voice box (thyroid cartilage) and shortens the vocal cords before putting the voice box back together. I have added in this iteration of the surgery, the suspension of the larynx from the hyoid as well. I have been calling the procedure FemLar, short for the Femininization Laryngoplasty.

These recordings are set to a fairly low resolution for the internet but do demonstrate the general sound and function of the vocal cords before and after this case of laryngeal reduction surgery. Much more detail is actually visible in the office. The videos when shown are oriented with the front down and the left vocal fold is on the right of the video. Orientation is discussed here. Please note: These examples of possible results should not be construed to represent what will be acheived in any other patient.

There are many components to a voice exam. I have selected ones here that I feel change the most with this type of surgery.

 

Pre Surgery

7 weeks

recorded with VHS camera, not a professional microphone so there is a bit of an echo

6 months

 

Reading passage

Pitch is described relative to C4 or middle C on the piano.

    

Pitch: about C3

(typical male speaking range about B2 - E3)

Pitch: about G3 (about 7 semitones higher than pre-op)

(normal female speaking range about E3 - A3)

Pitch:

 

Lowest pitch

    

Pitch: about A2# (normal male low range varies C1 - C3)

Pitch: about D3 (normal female low range varies between B2 - F3) this is a glide from high to lowest pitch. It is about 4 semitones higher. (there is a dog in the background)

Pitch:

  

Highest pitch

    

Pitch: about E4

Pitch: about D5 - this is a glide from low to the highest pitch. (not quite an octave higher)

Pitch:

  

Vegetative sounds

coughing & throat clearing

    

Pitch:

Subtle difference?

Pitch:

  

Yell

loud phonation

    

 

A little rough quality

 

  

Laryngoscopy

Views during respiration to get a close up view.

      
View of cords.
 
    

Stroboscopy

saying the sound /i/

      
Views at low and high pitch. Some thick secretions.

click for larger video
 
    

Spectrogram

Running speech

        
       
The surgeon’s comments:

This is one of the patients whom I have been able to obtain a follow up voice recording on. She was willing to perform the tasks and then mail me the audio recording. The sound quality differs from pre to the 7 week recording.

In the immediate post-operative period (first several weeks) her pitch was lower than pre-operatively. It gradually rose.

 
The patient’s comments: