Relaxation thyroplasty for mutational falsetto treatment.

Mutational falsetto voice is considered to be a psychogenic disorder associated with the rejection of adulthood. The initial treatment must include speech therapy and psychotherapy. However, delayed treatment and denial of the problem can cause the disorder to become recalcitrant to behavioral treatment. Modified relaxation (type III) thyroplasty was proposed by Isshiki to shorten the vocal folds and release tension by incising and depressing the anterior segment of the thyroid cartilage. This procedure is called relaxation thyroplasty by a medial approach (anterior commissure retrusion) in the European Laryngological Society classification system. It results in a lowering of the vocal pitch. The surgery can be performed under local or general anesthesia. It should only be considered for cases not improved by speech therapy and psychological counseling. Our series included 7 male patients with a mean age of 21 years who underwent modified relaxation thyroplasty after failure of behavioral management. The assessment of outcomes was based on changes in the fundamental frequency of the voice and the Voice Handicap Index. The mean fundamental frequency was lowered from 187 Hz to 104 Hz (p < 0.001), and the mean Voice Handicap Index was improved from 70 to 21. There were no postoperative complications. The voice results were consistent over a mean follow-up of 17 months. Modified relaxation Isshiki (type III) thyroplasty is a successful treatment option for lowering vocal pitch in cases of mutational falsetto voice recalcitrant to conservative therapy.