considering voice surgery with haben

[ClassOf91]

I actually transitioned back in 1989 and had surgery with Dr. Biber back in 1991. I've been fortunate enough to simply be able to live my life without my past being obvious. Voice, which was my biggest concern, at the beginning has been passable though at the low end of passable. It sounds worse to me than it does to others. Those who know my past tell me it sounds fine and I am rarely misgendered on the phone but it's still my biggest area of concern.

I get to maybe 185Hz on a good day though the prosody is good enough that it seems to work for people.

I had a consultation with Dr. Haben today and his recommendation was for the glottoplasty with the CTA. The reason was that due to years of tension on my vocal cords, the amount of closure he'd be able to safely do on the glottoplasty would be about 30% and he didn't think that would provide enough change on its own.

I'm now trying to weigh the pros and cons and finding it difficult, in part because I can't find a lot of examples out there on the net and most of what I find are from Yeson. Traveling to Korea for surgery makes me uncomfortable because of the relative inaccessibility should follow up be necessary. Based on what Dr. Haben showed me today I might not be a good candidate for Yeson anyway.

I'm a bit uncomfortable with sharing samples publicly though I'm happy to do so privately. I'm hoping that there are some people who have had the combined procedure with Dr. Haben would be willing to share with me the before and 6 month plus results. It would help a lot in terms of knowing what to expect.

I've also got one last question, regarding the praat software. Does anyone know if it's pitch shifting function produces realistic results? That is, does taking an unplaced voice and shifting it up 80hz provide a good approximation of a surgical result after healing? I'm hoping the answer is actually no since it sounds a bit unnatural to me.

Thanks, in advance, and hope to make some new friends here!

[Dena]

Welcome to Susan's Place. Your post is deja vu as that is pretty much why I joined the site a little over two years ago. I only had the glottoplasty as Dr Haben felt he could get a sufficient pitch increase without CTA which he did. My starting head voice was 130-140 hz and I had a near 50% tie which pushed my voice into the 220 hz range. Dr Haben said he could only promise me about 60 hz but he came closer to 80. Had it been needed, I would have added CTA to the surgery however if it was possible, I wanted to avoid it as it would reduce the voice flexibility. If you look on Dr Haben's web site, my voice is the the 64 year old sample.

I also visited with Dr Biber in 1982 so we have that in common as well. Feel free to ask me any questions as I am willing to share what I know.

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[ClassOf91]

Thanks for your response!

I've tried to listen to the samples I can find on the net but most seem to be from Yeson and from looking through old posts here most samples have vanished over time so I can read what people wrote about them but haven't been able to hear the results. Perhaps as someone who has heard the samples you can characterize how much improvement people made, how wide a distribution in results there was, that sort of thing.

I'd also be happy to send you a vocal sample so you can hear where I am now and give me your opinion.

I'm a bit leery of the CTA but Dr. Haben was pretty certain that this would be the only way to get enough pitch change since he felt the amount he could safely do on the glottoplasty was limited. I haven't heard many but a lot of the CTA results I've heard have been fairly squeaky and I don't want to end up with that kind of result but don't know how to make any sort of reasonable prediction.

[Dena]

I am also a bit confused as to exactly what CTA does. I have heard a few voices here from people who had both surgeries and the voices sounded pretty good and were not squeaky after sufficient healing time had passed. I suspect if you ask Dr Haben, he has CTA follow up voice samples that you might be able to hear.

One thing that will cause a squeaky voice is if the tie is over 50%. It can also happen if the healing process causes more that the expected amount of vocal cord to fuse.

CTA was the surgery that was used before glottoplasty became popular and it's still the surgery of choice in some of the european countries. The problem with it is that sometimes it's not enough to provide the needed pitch change but when combined with glottoplasty, it can provide more shift than either surgery alone.

I could be wrong but it appears that CTA seems to force you into the head voice. That would explain the loss of ability to sing as it would restrict access to the lower pitch ranges. The people who I have heard who had CTA weren't that deep into understanding voice so I wasn't able to get any information to back up or disprove this theory.

[kwala]

Thanks for your response!

I've tried to listen to the samples I can find on the net but most seem to be from Yeson and from looking through old posts here most samples have vanished over time so I can read what people wrote about them but haven't been able to hear the results. Perhaps as someone who has heard the samples you can characterize how much improvement people made, how wide a distribution in results there was, that sort of thing.

I'd also be happy to send you a vocal sample so you can hear where I am now and give me your opinion.

I'm a bit leery of the CTA but Dr. Haben was pretty certain that this would be the only way to get enough pitch change since he felt the amount he could safely do on the glottoplasty was limited. I haven't heard many but a lot of the CTA results I've heard have been fairly squeaky and I don't want to end up with that kind of result but don't know how to make any sort of reasonable prediction.

Just to help you make an informed decision: Dr. Haben badly botched my voice surgery 2 years ago and tried to correct it in a second operation but only made my problems worse.  I had to seek help from another medical team just to get some basic vocal functions back. I can speak softly again, but my voice is still crippled to this day. Just be aware that if he tells you the only risk is not enough pitch increase, that is this is not true. Not trying to discount any of his successful results but I've heard from several patients whose voices have been permanently damaged in his hands. Best of luck with your decision.

[ClassOf91]

Oh, kwala, that sound truly horrible. Thanks for sharing your experience with me. I know it must be painful for you.

Dr. Haben did tell me that things could go wrong and that complications beyond simply failing to make the desired pitch change were possible.

For me that's the biggest fear. I get by now. The world doesn't misgender me except for rare circumstances. But, my average pitch is probably only 170hz on a good day. To me, every time I speak, I hear the past even though others don't. I've had people tell me my voice is soothing and relaxing and while that's nice to hear it doesn't provide the kind of self validation I seem to need.

If it were just that I'd probably not consider VFS but I'm concerned about the long term health of my voice. I've been doing this for 27 years now (I'm 53) and I can feel the wear on my voice. Dr. Haben showed me how the long term tension on my vocal cords has had a physiological affect. He says there is no immediate danger but eventually could lead to vocal strain.

If it weren't for the variability in results it would be a much easier decision. That variability kept me from considering it for years but now, with my extra concerns, it seemed worth investigating. Fortunately, I don't need to make an immediate decision but, at this point, I don't feel like I have enough information to make a good decision.

[Dena]

That is the gamble. My starting voice was so low that my trained voice was still gendered male. I was cursed with a bass voice, think Johnny Cash. I figure I wouldn't be much worst off if the surgery didn't work but I wasn't sure if everything went right I would end up with a feminine voice. If you are passable with your current voice, there is a risk of losing what you have and the decision becomes much more difficult.

Dr Haben is pretty good at responding to questions so I suggest you spend a few weeks making a list of questions and send it off to him. Also feel free to ask me questions as I have been watching the voice forum for over two years and I have studied voice for a long time before that. Most of the surgeries go well but you don't want to be the one that fails.

[kwala]

Oh, kwala, that sound truly horrible. Thanks for sharing your experience with me. I know it must be painful for you.

Dr. Haben did tell me that things could go wrong and that complications beyond simply failing to make the desired pitch change were possible.

For me that's the biggest fear. I get by now. The world doesn't misgender me except for rare circumstances. But, my average pitch is probably only 170hz on a good day. To me, every time I speak, I hear the past even though others don't. I've had people tell me my voice is soothing and relaxing and while that's nice to hear it doesn't provide the kind of self validation I seem to need.

If it were just that I'd probably not consider VFS but I'm concerned about the long term health of my voice. I've been doing this for 27 years now (I'm 53) and I can feel the wear on my voice. Dr. Haben showed me how the long term tension on my vocal cords has had a physiological affect. He says there is no immediate danger but eventually could lead to vocal strain.

If it weren't for the variability in results it would be a much easier decision. That variability kept me from considering it for years but now, with my extra concerns, it seemed worth investigating. Fortunately, I don't need to make an immediate decision but, at this point, I don't feel like I have enough information to make a good decision.

Glad to hear you're taking your time. I agree with others that about researching as much as possible and never being afraid to ask too many questions.  Wishing you luck with whatever you end up deciding!

As for myself, I'm not ready to give up on my voice yet and am heading to Yeson this summer to see if Dr. Kim can alleviate some of my vocal problems.  I worked with a speech pathologist for the past year and although we've had some breakthroughs, even she agrees that we've reached the limit of what my voice can do without medical intervention.  Fingers crossed!

[KimSails]

I had surgery with Dr. Haben in December.  I did the simple glottoplasty.  Of the two sutures to close the vocal chords, one worked and one broke.  I never felt it break, but it was discovered at a 3-month check-up n March with Dr. Haben.

I ended up with a little improvement, but not what I was hoping for.  At six months my voice is still often very hoarse-sounding, but sometimes it sounds better (not *as* hoarse and easy to place a bit higher than what I could do prior to surgery).  I hope that a further six months of healing will reduce the hoarseness.

Prior to surgery I was mis-gendered on the phone nearly 100% of the time.  Now it is more like 80-90% of the time. I don't know that my case is all that similar to yours, but I expect that it is better to get lots of perspectives.

[kwala]

I had surgery with Dr. Haben in December.  I did the simple glottoplasty.  Of the two sutures to close the vocal chords, one worked and one broke.  I never felt it break, but it was discovered at a 3-month check-up n March with Dr. Haben.

I ended up with a little improvement, but not what I was hoping for.  At six months my voice is still often very hoarse-sounding, but sometimes it sounds better (not *as* hoarse and easy to place a bit higher than what I could do prior to surgery).  I hope that a further six months of healing will reduce the hoarseness.

Prior to surgery I was mis-gendered on the phone nearly 100% of the time.  Now it is more like 80-90% of the time. I don't know that my case is all that similar to yours, but I expect that it is better to get lots of perspectives.

Hi, Kim. I also elected for only the glottoplasty (no CTA). My stitches held, but Dr. Haben placed them too high up which resulted in a sort of super web that covered something like 3/4ths of my cords. His initial response to my question about the worst case scenario was "Don't worry about it."  After six months of being nearly unable to speak and having another ENT take a look his response changed to "I can't control the way people heal." I sincerely hope your voice improves with time but I can tell you that my hoarseness was very present even a year after surgery. And even now, close to two years later with the web removed, the portion of my vocal cords that were previously webbed are now scarred from being burned together and then split apart which makes me sound like a manly chain smoker.  There was another girl here who experienced incomplete cord closure because of the way her web healed and getting prolaryn gel injections greatly improved her volume and clarity- might be something to look into in the future if your problems remain.

[ClassOf91]

Thanks, again, to everyone for their insights. It is very much appreciated. I recorded a sample of the rainbow passage to show where I am today. I'd appreciate hearing what people think.

http://vocaroo.com/i/s05ifgFQkLr8

From a pitch perspective, this only gets to 165 or so on average but people seem to accept it, even on the phone. It's more me that it bothers more than anyone else.

[kwala]

Thanks, again, to everyone for their insights. It is very much appreciated. I recorded a sample of the rainbow passage to show where I am today. I'd appreciate hearing what people think.

http://vocaroo.com/i/s05ifgFQkLr8

From a pitch perspective, this only gets to 165 or so on average but people seem to accept it, even on the phone. It's more me that it bothers more than anyone else.

Room for improvement, but it's a definite pass from me.  Before all these surgeries I was typically in the 160-170 range also and really wish I had just left well enough alone. I'd definitely try therapy/exercises and see how far you can get that way before taking any unnecessary risks. But that's just me. Anyway, you're off to an excellent start and I would for sure call you ma'am if I heard that voice on the phone.

[Dena]

The voice is pretty good as it contains the required components. The pitch is in the gender ambiguous range however the inflection and breathiness is sufficient to pull it into the feminine rage. If you have to put a lot of effort into producing that voice, I can see where Dr Haben would be nervous about a 30% tie and is considering CTA. If the voice was natural and relaxed, I would guess that a 30% tie would be sufficient to push you well into the feminine range.

[ClassOf91]

Dena, your analysis pretty much matches my self assessment.

I don't (consciously) strain to produce it. It feels pretty natural to me but apparently what I feel and what my vocal cords feel are two different things.  I think there is unconscious tension that I learned to create way back when and this probably wasn't the proper way to do it but there were no resources available to learn from back then.

I'd consider going for speech therapy but the one place I've learned of that is in the area is not close so it would be a challenge to arrange a regular schedule. Not impossible, but definitely challenging. I'm hoping to contact them tomorrow to see if I can arrange a consultation. If they think I can get to where I want to be without surgery then that's an easy choice.

Dr. Haben was comfortable with a 30% tie but didn't think it was safe to go beyond that which is why he was recommending the CTA in addition. If I did just the glottoplasty and then still had to use a placed voice then I'd probably need speech therapy to avoid recreating the current tightness. In that case I'd try to correct it entirely through speech therapy first before opting for surgery.

[Dena]

For this test, make a Eeeeeeeeeeeeeee sound. Vary the pitch up and down until you figure out where your voice is the strongest. This should be where you should be centering your pitch but you may work above and below that pitch as needed.

Next, I am assuming that you are using the head voice. If you aren't sure what this is, it's when you tighten the muscles between your larynx and your jaw causing your larynx to move up. A way to find this voice is starting in your chest voice/male range, you increases your pitch and your voice will break when you cross over into the head voice. You need to remain above the break point to remain in the head voice.

My therapist wrote the book on treatment of voice problems with speech therapy so I learned a good deal about avoiding voice problems from him. Many problems can be treated without surgery if they were caused by abuse but there are still issues that may require surgical intervention.

[ClassOf91]

Thanks Dena, kwala and Kim. Your experiences and insights are very much appreciated.

Dena, your test puts me at the pitch where I currently am so it looks like I got the right place intuitively all those years ago. I've just never been able to get beyond where I am now. I think the tightness I feel in my throat is the muscles you are describing to get into head voice. I think I tense them unconsciously and have to work to relax them. That's what I feel that pushed me over the edge to consult with Dr. Haben. If speech therapy can teach me how to relax those muscles when not in use then great. If it can push the pitch even a little, then really great. Hopefully I'll know in a couple of days how long it will take to get an appointment.

I'll report back what I learn. If my experiences can be of use to anyone else I'm happy to share.

[ClassOf91]

@Bebe5581, I got your PM but I don't have the ability to reply to it at this point as I guess I haven't posted enough.

At this point I have not decided to pursue VFS. I'm still weighing options. I'm hoping to speak with a speech therapist to see if they think I can get beyond what I've learned to do on my own but so far haven't had any luck in finding someone within driving distance.

I'll be happy to share more once I figure out what is happening but for now that's all I have to report.

[ClassOf91]

Back in June I wrote that I was going to pursue voice therapy before resorting to surgery. I was eventually able to get involved with the speech therapy center at George Washington University in DC starting in mid-September. I'm now about six weeks into it but I think there has been measurable progress!

Here's a recording from this afternoon. This is up about 45-50 Hz from where I was before. Prior to therapy I could hit this pitch but not comfortably and not have it sound at all natural. I'm not there reliably yet but this is definite improvement. I've also been able to reduce a lot of the tightness I had been feeling so overall it's improvement.

https://vocaroo.com/i/s0gr8iztFCni

[Dena]

You are doing well with your voice. While it needs a little more work, I think that you could pass with it and your voice wouldn't give you away. The pitch is good but the speech pattern is still a little flat. You would need to work on this even if you had surgery so what you are working on now wouldn't be wasted in either case.

[kwala]

Back in June I wrote that I was going to pursue voice therapy before resorting to surgery. I was eventually able to get involved with the speech therapy center at George Washington University in DC starting in mid-September. I'm now about six weeks into it but I think there has been measurable progress!

Here's a recording from this afternoon. This is up about 45-50 Hz from where I was before. Prior to therapy I could hit this pitch but not comfortably and not have it sound at all natural. I'm not there reliably yet but this is definite improvement. I've also been able to reduce a lot of the tightness I had been feeling so overall it's improvement.

https://vocaroo.com/i/s0gr8iztFCni

I think you sound truly great. My only criticism (and I think this is related to what Dena is talking about) is that with every pause I can almost hear you thinking/concentrating on staying in that pitch range. That's to be expected when your learning. I really believe  if you stick with it that this will eventually become second nature and any issues with prosidy or timing will work themselves out because you'll just be speaking freely. Congrats on even more progress!