Surgical alteration of the vocal pitch.

Vocal pitch can be changed surgically without distorting the vocal quality. It can effectively be lowered by thyroplasty III, that is anteroposterior shortening of the thyroid ala by vertical strip excision of the cartilage. The pitch lowering was dramatic in six, but fair in three where the vocal cords were atrophic or scarred. Vocal pitch can be elevated by various surgical techniques: 1) cricothyroid approximation, 2) A-P expansion of the thyroid ala, 3) longitudinal incisions in the cords, 4) intrachondral injection of the steroid, and 5) evaporation of the cords by CO2 laser. Cricothyroid approximation, performed on 11 patients, generally produced substantial rise in pitch, which was limited, however, when the cords were very thick. The intrachordal surgeries, 3-5, should be performed conservatively, because it may interfere with the vocal cord vibration.