# Cricothyroid Approximation in Trans Women With Type A Cricothyroid Joints

## TL;DR

Cricothyroid approximation surgery helps trans women with a specific joint type achieve a higher, stable voice pitch for up to five years.

## Contribution

The study demonstrates long-term stability of voice pitch elevation in trans women with Type A cricothyroid joints after cricothyroid approximation.

## Key findings

- Mean speaking level increased from 134 to 203–209 Hz after cricothyroid approximation and remained stable for 5 years.
- Trans Women Voice Questionnaire scores improved significantly after surgery and remained stable.
- Cricothyroid approximation should only be performed in patients with Type A cricothyroid joints.

## Abstract

In trans women, low‐pitched voice can be raised by cricothyroid approximation (CTA). The aim of the study was to analyze voice outcomes in trans women with Type A cricothyroid joints (CTJs) over a period of 5 years.

Prospective cohort study.

Thirty‐five trans women were included in the study after high‐resolution computed tomography evaluation revealed a Type A CTJ (Type A: well‐defined facet; B: no definable facet; C: flat cartilage surface). All had voice therapy before CTA. Additionally, voice assessment (mean speaking level [MSL], loudness, vocal range of speaking voice, Trans Women Voice Questionnaire [TWVQ]) was performed before and after voice therapy, and after CTA at 4 weeks, 6 months, and 1 year, and then annually for 5 years.

MSL rose with voice therapy from 134 to 150 Hz. With CTA, the MSL increased to 184 Hz 4 weeks postoperatively and to 199 Hz 6 months postoperatively. The MSL has remained stable at 203–209 Hz for 5 years. The TWVQ score decreased from 91 to 84 patients with voice therapy. After CTA, it decreased to 50 patients and has remained stable for 5 years.

CTA in trans women with Type A CTJ is a valuable technique for elevating MSL, providing stable results for 5 years. Therefore, CTA should only be performed in patients with Type A CTJs who desire higher pitched voices.

Level 4.

Cricothyroid approximation is a proven technique to increase the speaking voice in trans women. We were able to show in a group of patients that this operation increases the speaking voice in trans women with a Type A cricothyroid joint (CTJ) and remains at a stable high level for several years. Thus, if a cricothyroid approximation is indicated, an HRCT should be performed first to confirm a Type A CTJ.