Phonosurgery

What is Phonosurgery?

People may seek voice changes for various reasons. For instance, a man who has received a promotion may wish to have a deeper and more authoritative voice, or a transgender individual may want their voice to align with their new gender.  Medical procedures performed for these and similar reasons are referred to as voice altering operations (Phonosurgery).

How is Phonosurgery Performed?

Phonosurgery is a relatively new concept and has become more widely accessible and easier to perform thanks to advancements in surgical techniques and medical technologies over the past decade. While the term “altering” in the context of voice may seem utopian, current surgical techniques allow for the modification of normal voices. Desired or nearly desired voice altering can be achieved using these techniques or their combinations.

Voice Thinning

Voice-thinning surgery is performed to achieve a thinner voice in women who naturally have a deep voice, whose voice has deepened due to factors such as smoking, or after gender transition.

How is Voice Thinning Surgery Performed?

Voice-thinning surgery is typically performed under local anesthesia, either through an incision in the middle of the neck or via the mouth.

The most common technique for voice thinning is Type 4 thyroplasty. This involves bringing the two large cartilages in the larynx closer together and elongating the vocal cords to thin the voice. During the procedure, both the surgeon and the patient listen to the patient’s voice, and together, they decide when the voice has been sufficiently thinned.

Two other techniques, Wendler thyroplasty and laser thinning (LAVA), are also becoming increasingly common. In Wendler thyroplasty, the anterior third of the vocal cords is sutured together to shorten the vocal cords. In LAVA, a laser is used to reduce the mass of the vocal cords, resulting in a thinner voice.

There is no hospitalization required after voice-thinning surgery, and it is not a painful procedure. Following thyroplasty, the voice should be rested for one week. Voice therapy during this period can also be beneficial.

Voice Thickening

Voice-thickening surgery is performed for individuals with naturally thin voices, mutational falsetto, congenital vocal cord collapse (sulcus vocalis), or those seeking to deepen their voice after gender transition.

How is Voice Thickening Surgery Performed?

There are various techniques for voice-thickening surgery, but the most common is the Type 3 thyroplasty technique. The surgery is performed either through the mouth or via the neck, typically under local anesthesia. By reducing the size of the thyroid cartilage, the vocal cords are loosened, resulting in a deeper voice. Since the patient remains awake during the procedure, the desired voice depth is adjusted based on their preferences.

Two other techniques, Relaxation thyroplasty and Baklava thyroplasty, are also becoming more widespread. These procedures are performed under local anesthesia and involve a similar incision.

Voice-thickening surgery does not require hospitalization and is not a painful procedure. After the surgery, the voice should be rested for one week.

Voice Hygiene

Protecting your voice from all negative factors is referred to as “Voice Hygiene.” Voice hygiene is particularly important for individuals who use their voice professionally.

How to Maintain Voice Hygiene?

To maintain voice hygiene, you should:

• Avoid speaking loudly, shouting, or screaming.
• Instead of coughing to clear your throat, swallow after sniffing or drink water.
• Avoid long phone conversations.
• Rest your voice by taking a 5-minute break every hour during the day.
• Refrain from frequent and forceful throat clearing or coughing.
• Avoid speaking in noisy, dusty, or smoky environments.
• Ensure you get adequate sleep and try to avoid sleep deprivation and excessive stress.
• Keep the air in your surroundings as humid as possible.
• Aim to drink at least 8 glasses of water daily.
• Smoking is one of the most detrimental factors for vocal hygiene.
• To prevent reflux, avoid sleeping on a full stomach. Try to sleep with your head elevated (using a double pillow).
• Avoid consuming excessively fatty foods.
• Do not use aspirin or blood-thinning medications unless absolutely necessary.
• Avoid taking medications that affect your mental state (e.g., antidepressants) unless necessary, as they can impair voice control and cause dryness in the vocal cords.
• Antihistamines and pseudoephedrine-containing medications used for colds and flu can dry out the vocal cords.
• Avoid diuretics unless absolutely required, as they can also lead to dryness in the vocal cords.
• Hormonal medications (e.g., birth control pills) can cause changes in your voice.

Conditions that cause nasal congestion (e.g., nasal allergies, deviated septum, sinusitis, adenoids, and nasal polyps) can negatively impact your voice and should be treated.