Susan's Place Transgender Resources

Hi all,

having hijacked another post with updates about my own surgery here in the UK a week ago, I thought I'd keep my own one here seperate for anyone interested.

So I had the Wendler Glottoplasty, performed here in the UK at Newcastle Freeman hospital by the lovely tiny Scottish professor Janet Wilson.  I'm at present 1 week into my 2 week completely silent period, and have maintained that without real issue.

It's not coughing or clearing my throat that has proved exceptionally difficult, and increasingly difficult as time has gone on, causing me much anxiety.  This culminated a few moments ago in a cough building up (via lots of little splutters) which suddenly sprang on me and caused a panic attack as I immediately had a horrible "glob" of something in my mouth !  :o

I absolutely feared the absolute worst, but when I spat it out - it was a clear glob of.. goo.  Im desperately hoping this was just excess fluid and/or fibrin glue that I'd inhaled previously.  I'm in no pain (other than the general post-op discomfort I've had anyway) and can if anything, breathe easier now.

I've emailed the professor for advice nonetheless!

Kate

Was probably the super glue that came up.

lol, super glue.  funny way to think about it!

Quote from: thegreenrabbit on August 27, 2014, 01:44:20 PM
Was probably the super glue that came up.

Probably felt like gaffa tape I'd imagine, but good you got rid of it.

Was this private or nhs?
I'd love to hear more!

NHS, but only after a very long fight since I couldn't afford any more private work for the forseeable future!  My local sexual-health specialists (who worked as kind of "secondary" to the proper GiC) were far more amenable than the "official" GiC I'd attended since beginning my transition 7 years ago.

Kate, when you say "Yeson Style", is the surgery performed without an incision to the neck?

Specifically its the endoscopic technique anterior commisure/vocal fold shortening, using micro-scissors/scalpels, as opposed to laser.

Thanks, Kate. How is access gained to the vocal cords, is it through an incision to the neck or is it via the mouth?

Hi yes, standard procedure via the mouth, thats what endoscopic means ;)  No incision.

Quote from: Kate_H on August 27, 2014, 02:45:47 PM
Hi yes, standard procedure via the mouth, thats what endoscopic means ;)  No incision.

Neat! Do you know if Wendler studied the Yeson technique? According to this study...

http://www.ncbi.nlm.nih.gov/pubmed/23809571

...the extent of pitch increase is similar to what Yeson achieves. However they seem to use sealant over top of the stitches, plus a longer full-rest period? That's curious. However it's a small sample size (18) and 3 needed revisions, which I understood Yeson's revision rate to be minute.

I've not looked up audio samples of Wendler glottoplasty results, but I'd be curious what (if any) the differences are in terms of sound.

Can't tell you much more, my decision to go with the procedure was based on other threads here in the forum comparing the Glottoplasty to Yeson, and Marc Remacle's laser procedure.

Here's a far more detailed report on the procedure, confirmed by my surgeon to match her process, aside from her use of scalpels instead of laser:

http://kate-z.unospace.net/wendglot.pdf

I know about endoscopy, just making doubly certain that means no neck scars! Well, that's certainly interesting. I'd be interested to hear results from Janet Wilson's surgery, and if they're as good as Yeson's. You may not know as you had yours done under the NHS, but I wonder how much she charges private. I was offered CTA under the NHS in the 90's, but rejected it because the results were undesirable. However, I did develop a female voice, but it would be nice to remove the potential to go below a certain pitch and subtlety improve the timbre, as Yeson does seem to do.

Someone else here on the forum managed to glean a figure of £3000ish which is pretty darn reasonable... However. .. It seems the Prof is a little hard to nail down with regards private work!

QuoteRESULTS:

Group A included 19 individuals with mean age of 28.6 years (range: 16-39 years) and group B included 12 individuals with mean age of 51.9 years (range: 45-59 years). The mean follow-up period was 9.2 months. Three cases had previously undergone a cricothyroid approximation elsewhere. We found a significant improvement of mean F0 from 135.8 to 206.3Hz in total (P = 0.001) and also in both groups, especially in group A (mean F0-postop = 213.8Hz). The mean frequency range had a tendency to decrease postoperatively, whereas the ESGP was significantly higher in both total sample and group A (P = 0.001, respectively). G was increased postoperatively and presented a statistical significance in group B (P = 0.035). A revision Wendler procedure was necessary for three individuals (9.7%); two of them presented a suture's line breakdown because they did not follow the postoperative recommendations for voice rest and the third one had an insufficient web due to an insufficient estimation of the necessary correction.

from the paper cited above

So it is again showing just how important post op care is, but also shows that there is quite a strain on this new commissure post op in the long run.

The pitch increase seems to be great, the higher ESGP  and G are not reall sounding great. Especially a higher G which translates into breathiness, hoarseness etc.

Interesting to read that the pitch lowered with time, while Dr Kim says it actually inreases during the first year, but maybe that means it lowers later on? I gues this is natural, so the pitch inrease in any voice surgery seems to be a bit degrading with time as all stretches out.

Age seems to play a role too.

they use only 2 stitches and lasers in the paper, not microscalpels and 3 stitches. Yeson uses 3 stitches and seems to "taper" them, which may be a big advantage.

To have someone do this in the UK is intersting. how often did they perform this procedure there? Are there no former patiens who have writtena bout it or given voice samples?

I interpreted the reduced frequency range to refer to the overall loss of range due to lower frequencies being made unavailable?

Interestingly whilst at the hospital staff made the following observations:

I was coming to the surgery with one of the "best" pre-op voices, "top end of scale" in terms of natural female sound, so they were particularly interested in my final result.

Secondly, and quite concernigly,  they also said that I was performing flawlessly in the "no voice use" Post-op,  as opposed to previous patients!!!!!

4 days to go until my first utterance.  Surgeon is not concerned about my minor coughs, which certainly made me feel better, but we'll see.

Hiu Kate.
Yes, the vocal range of course goes down due to the loss at the low end which is usually not compensated at the upper end in the same amount

But the estimated subglottic pressure (ESGP) and grade of dysphonia (G) are a bit concerning. Sadly I cannot access the paper from my university account, so I dont know how severe that is. With Dr Gross in 1999, G increased by one point (out of I think 4 or 5? ), which is not good. With Yeson I had the impression it was less, others I dont know any data.

Quote from: Kate_H on August 30, 2014, 06:51:15 AM
I was coming to the surgery with one of the "best" pre-op voices, "top end of scale" in terms of natural female sound, so they were particularly interested in my final result.

Ok, so that will really be interesting then to see if your voice will be even better then post op. I think Yeson sees more of the women with good voices already who want to improve, in Europe a voice surgery is probably more often used as a last resort attempt of people who just cannot get a female voice otherwise and are happy with anything that makes that go away. Sadly this means that they still use CTA a lot which gives suboptimal results but seems to please those desparate enough in that at least it is an improvement at all.

Quote
Secondly, and quite concernigly,  they also said that I was performing flawlessly in the "no voice use" Post-op,  as opposed to previous patients!!!!!

In what sense? Just keeping the no voice restriction and the no alcohol, cigarettes and coffee restriction? I dont get that. why are people at Euro surgeons like that. Also here in Germany - almost all I talked to (and who had not the best voices reall) did not follow those restrictions and smoked, tried to talk etc. Why? Dont they care as much as those travelling to Korea for this? Is it just the more you invest the more you care about it?

Hey Kate : ).

Just wondering if you're happy with the final results after all these months?

Does anyone know how to arrange to do this surgery privately with Janet Wilson? I tried sending her an email, but had no reply, and I'm unsure how to enquire/arrange for this privately through more official channels.

The administration is abysmal, though it may have changed since I last tried.

Quote from: Dash on April 11, 2015, 12:14:17 PM
Hey Kate : ).

Just wondering if you're happy with the final results after all these months?

Does anyone know how to arrange to do this surgery privately with Janet Wilson? I tried sending her an email, but had no reply, and I'm unsure how to enquire/arrange for this privately through more official channels.

Hi! Overall, yes - but the healing seems to be quite long for me - volume is limited for me, if I try to raise my voice I get very hoarse indeed, my voice has been described as "husky" - in a good way!  Overall effect is very good, but even with all the information I had going in, I still didnt expect it to be the way it is.. I think I still kind of thought that my voice would have a pitch transposition of sorts, whereas ofcourse what it does is remove the ability to go to my former low-pitch - which is what it should be really, I had to learn to speak at a new minimum pitch - which is what therapy before and after has been about.  When I'm lazy I tend to "bottom out" at the the near bottom end of my pitch range, which makes it VERY hoarse indeed.  When I'm talking normally, however, its fine :)

I've attached spectrograph details.

with regards getting in touch with Janet - yes, I think anyone after me has found it problematic, and a bit symptomatic of the way the NHS services at the Freeman hospital work - even when approaching from a private angle.  I was very lucky to have direct dealings with Janet from day one.  Or sort of.  After the fantastic news that my local NHS would fund the surgery with Janet... nothing happened for months through official channels until I contacted her personally and directly...  after that I had a consultation within 2 weeks, surgery a couple of months thereafter!

A recent scope with Janet (late January) showed some still healing/swollen sections which were causing the occasional dysphonia - notably hoarseness and diplophonia (the effect of soundling like you have two voices) but she was delighted with my progress nonetheless... and I'm able to hear my own voice now without getting upset... so... success! :)

(https://www.susans.org/proxy.php?request=http%3A%2F%2Fkate-z.unospace.net%2FKate-Spectrographs.png&hash=a1717f488392c8654fa8a4c03629c7b7efac8acb)

Interesting post. So really the glottoplasty functions in the same way that a gastric band operation limits obese people from eating, only in the case of voice glottoplasty limits the ability to return to a lower pitch. Hence why speech therapy is also important.

Thanks for the replies ladies. A very informative post above, so thanks for the information Kate : ).

I'm glad you're happy with the surgery, even if it didn't turn out quite how you anticipated.

Janet Wilson replied to me today, so fingers crossed the ball is moving.

Quote from: thegreenrabbit on April 12, 2015, 12:11:58 AM
Interesting post. So really the glottoplasty functions in the same way that a gastric band operation limits obese people from eating, only in the case of voice glottoplasty limits the ability to return to a lower pitch. Hence why speech therapy is also important.

I am not sure this describes it well. In a way yes, it eliminates the ability to do the lower pitches but the brain sometimes thinks they still are there and remembers that it used to be more relaxing to use them, except now these pitches are only possible by forcing the pitch down. So I think the brain has to find out what is "normal" now. Also, it seems that the higher pitches are a lot easier to use and a relaxed sigh is at a different pitch now - so its not really just like something has been removed, but it really has changed overall. At least this is what I feel like, now 7 weeks post op from Yeson.

Yes, Anjaq pretty much nails it.  And where you *do* fall back to those pitches - they're not there anymore, resulting in either nothing at all, or at best a hoarse "funny" voice... that sounds.. well.. honestly.. like a cis woman "putting on" a man's voice.  Think about that for a second... and smile :)

Kate

In short, it's about learning new speech habits. One thing I've noticed since surgery is that I tend to breathe through the nose more. Probably because my mouth remains shut.

What an incredibly interesting thread. This shows me why I shouldn't be taking my eye of Susan's forums!!
I find it particularly intriguing when I read that the staff thought you came in with the best pre op voice. The reason is, I don't seem to ever had much problems in the voice department. but I do feel like there's times when I sound nasal or slightly forced.   my voice now would never justify a trip to Korea. My BF would absolutely think I'm crazy, but if it's done here and at a reasonable cost this could really be something to explore. Please keep sharing your experiences with Dr Janet Wilson! :)

X

Quote from: calicarly on April 27, 2015, 07:19:25 AM
What an incredibly interesting thread. This shows me why I shouldn't be taking my eye of Susan's forums!!
I find it particularly intriguing when I read that the staff thought you came in with the best pre op voice. The reason is, I don't seem to ever had much problems in the voice department. but I do feel like there's times when I sound nasal or slightly forced.   my voice now would never justify a trip to Korea. My BF would absolutely think I'm crazy, but if it's done here and at a reasonable cost this could really be something to explore. Please keep sharing your experiences with Dr Janet Wilson! :)

X

If you are happy with your voice then I'd not consider this type of surgery. No matter how good the surgeon, it's still a lottery on how the voice can end up.

Well everything I've read from everyone seems to indicate the opposite? I read that it's never a worse voice than before, and I do worry about my throat feeling somewhat strained despite the great voice, and how this could affect my vocal cords in the future, sometimes coughing brings depth to my voice that I dislike so I guess I'm not entirely happy, in comparison to everyone else, I should be. But if there is someone UK based I could go to then I do think I might have enough justification to seek maybe at least a professional consultation and see what I'm told?

Unless I'm not that well informed on what post op results have been for people but I have yet to come by anyone with a ruined voice? If so, I would appreciate some links :)

Def considering your opinion though, and one thing absolutely, I just can not justify goingall the way to Korea to Yeson, but I feel like I would if it was within the country.

Xx

Quote from: calicarly on May 09, 2015, 10:23:55 AM
Well everything I've read from everyone seems to indicate the opposite? I read that it's never a worse voice than before, and I do worry about my throat feeling somewhat strained despite the great voice, and how this could affect my vocal cords in the future, sometimes coughing brings depth to my voice that I dislike so I guess I'm not entirely happy, in comparison to everyone else, I should be. But if there is someone UK based I could go to then I do think I might have enough justification to seek maybe at least a professional consultation and see what I'm told?

Unless I'm not that well informed on what post op results have been for people but I have yet to come by anyone with a ruined voice? If so, I would appreciate some links :)

Def considering your opinion though, and one thing absolutely, I just can not justify goingall the way to Korea to Yeson, but I feel like I would if it was within the country.

Xx

A private consultation is actually most recommended. Why not do one over the phone and send what ENT info you have beforehand.
I think the price for this type of surgery is about 3 to 5K £ depending where its done. Two surgeons do it at the moment, one in London and one in Newcastle. The more experienced surgeon resides in London and a ortivate consultation would cist 500 £ including all of the tests. He is the UKs leading UK ENT surgeon. That's 3600£ in Newcastle and 5000£ in London.

Quote from: thegreenrabbit on May 09, 2015, 10:36:09 AMThe more experienced surgeon resides in London and a ortivate consultation would cist 500 £ including all of the tests. He is the UKs leading UK ENT surgeon.

Please might you be so kind as to share his name with us?
Many thanks in advance. ;)

Quote from: CollieLass on May 09, 2015, 11:05:22 AM
Please might you be so kind as to share his name with us?
Many thanks in advance. ;)

Dr. S something a the London ENT clinic near Harley Street.

I have the contact inofo on another computer, will post soon.

This the guy. He works out of Charing Cross and specialise in CTA and Glottoplasty. His CTA is not the standard, but is his own variant.http://www.thelondonclinic.co.uk/consultants/mr-gurpreet-singh-sandhu

Quote from: thegreenrabbit on May 09, 2015, 11:26:21 AM
This the guy. He works out of Charing Cross and specialise in CTA and Glottoplasty. His CTA is not the standard, but is his own variant.http://www.thelondonclinic.co.uk/consultants/mr-gurpreet-singh-sandhu

Consultation is 285£ + tests, total about 500£.

Quote from: thegreenrabbit on May 09, 2015, 11:27:49 AM
Consultation is 285£ + tests, total about 500£.

Thank you very much.  ;)

Quote from: thegreenrabbit on May 09, 2015, 10:36:09 AM
A private consultation is actually most recommended. Why not do one over the phone and send what ENT info you have beforehand.
I think the price for this type of surgery is about 3 to 5K £ depending where its done. Two surgeons do it at the moment, one in London and one in Newcastle. The more experienced surgeon resides in London and a ortivate consultation would cist 500 £ including all of the tests. He is the UKs leading UK ENT surgeon. That's 3600£ in Newcastle and 5000£ in London.

Thank you for the info greenrabbit !! i shall get in touch with both of them and then decide for a private consultation with one . :)

Hopefully we keep reading more experiences on either Doctor too.

:)

I think green rabbits words of caution should be taken seriously - for two reasons mainly.

One is that most results posted here are from one surgeon and then there are some results from 2 more surgeons. One of the main reasons for me to go all the way to Korea and not to Stuttgart or Berlin which is next door and much cheaper was that I had this impression - that there is little risk involved in doing this surgery with this surgeon. However, I would not have concluded that this general type of surgery is always like that. Yeson seems to have little risk, Dr Haben and Prof Remarcle have at least shown on some people in the forum here that they seem to do a good job - but I would always first check if the track record is good and the reputation of the surgeon is great (and can be believed). As I said before, the general surgical technique - creating a new commissure by suturing together the vocal folds in a section - is over 20 years old. Its the individual surgeons techniques details and the skill of the surgeons that lead to a good or bad success rate (for example in Berlin they told me that only 30% of the patients are happy with the result)

And the other point is - people who have done a surgery and it was not a success often dont talk about it anymore. Its hard to know then - some hints can be if someone reported going for a surgery, then never writing anything again about it - this can indicate a failure or it can indicate that the person is happy and just left the topic behind. So I would not trust the number of succes/failure stories online to judge for the realistic relationship between the two outcomes.

Carly, I just received an email regarding how much the operation costs (incouding consultation). I'll PM you the details. : )

Hi,
Very informative thread, good enough to get me to register here!
.
Pr Remacle, who was mentioned by someone,  was recommended to me by a speech pathologist as one of the references for Wendler Glottoplasty and based on publications of the subject, he does seem to have considerable experience.

I did a consultation with him in March and was told that with long, thin vocal cords (My natural singing voice is Barytone/Tenor), I should expect a good result.

I have tentatively booked the surgery for mid-July but still haven't completely made up my mind and would definitely be interested in getting feedback from anyone else who had has done this surgery with him.

For those that are interested, his price is just over 4300€ which includes two nights in hospital (CHU Namur - Godinne), the night before and the night afterwards.

I am a French citizen and, since there are no confirmed specialists in France, I was able to get an authorisation from our health insurance system to do it in Belgium using the S2 procedure : http://ec.europa.eu/social/main.jsp?catId=573.

With this, the French health insurance system will cover about 85% of the cost. If Pr Remacle is good, it looks like an interesting alternative to going to Korea, especially now with the dollar so high against the euro.

Hi Goddesses, welcome to Susan's. I'm so glad you joined. I look forward to seeing you around the site. Good luck and Hugs
Mariah

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Quote from: Dash on May 11, 2015, 10:28:07 AM
Carly, I just received an email regarding how much the operation costs (incouding consultation). I'll PM you the details. : )

PM'd back!! Thank you Dash!! :)

And thanks to Godinne also, interesting information!!

X