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 ! 

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.