Window anterior commissure relaxation laryngoplasty in the management of high-pitched voice disorders.

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.