Feminization Laryngoplasty - A Comprehensive Approach to Reducing the Size of the Larynx and Pharynx.

Feminization Laryngoplasty evolved from the aim to change a voice from a male quality to a female quality. Larynx and pharynx in a male have undergone enlargement during puberty and as there is no endocrine method for shrinking structures, a surgery that reduces the size of male structures toward the size of female structures might appropriately alter the voice. A smaller larynx and pharynx might raise both the fundamental frequency of the voice and the resonant frequency of the vocal tract. The surgery is used for transgender individuals who desire a female voice, for individuals who fail speech therapy and for complications of tracheal shave procedures whereby the vocal cords have been loosened.

Visual Neurolaryngology.

Visual diagnosis of laryngeal neurologic impairments is not only possible but is perhaps the most accurate method for evaluating the neurologic status of the upper airway. Precise assessments may lead to appropriate treatment without an EMG study. Principles of the neurolaryngology examination include: (1) each muscle has a single action; (2) that action can be elicited and to some degree isolated and visualized; (3) each muscle has an appropriate time to contract; (4) that timing can be compared to the opposite side; (5) inappropriate timing represents reinnervation; (6) inappropriate degree of motion represents reinnervation; (7) patients naturally compensate for any loss; (8) removing compensation during an exam reveals pathology. Some of the visual diagnostic findings available to the astute endoscopic examiner are (1) paralysis, (2) paresis, (3) synkinesis, (4) fixation, (5) tremor, (6) spasm, and (7) reinnervation.