Nasality outcome in unilateral chronic rhinosinusitis following functional endoscopic sinus surgery

The Effect of Concomitant Septoplasty and Turbinate Surgery on Nasality-Related Voice Parameters

INTRODUCTION

Our study aimed to reveal whether septoplasty and inferior turbinate reduction significantly impact the acoustic properties of nasalized syllables and alter subjective and objective voice parameters.

MATERIALS AND METHODS

Forty patients with nasal septal deviation and bilateral grade 2 ≤ inferior turbinate hypertrophy who underwent septoplasty and bilateral inferior turbinoplasty were enrolled. Participants completed the VHI-10, VAS, and NOSE scales preoperatively and at 6 months postoperatively. Changes in VAS and NOSE scores were calculated as VASchange and NOSEchange values. Voice recordings of the sustained vowel /a/ and the word /mini/ were analysed using MDVP. Acoustic analysis was performed with the sustained vowel /a/, and spectrographic analysis was conducted with the consonants /m/, /n/, and the vowel /i/ in /mini/. Recordings were taken preoperatively and at 6 months postoperatively. Statistical analysis compared pre- and postoperative values for significant changes using SPSS Version 21.0 (IBM Corp.; Armonk, NY, USA).

RESULTS

A statistically significant decrease in VAS and NOSE scores was observed at 6 months postoperatively (p < 0.05). No significant difference was found in VHI-10 scores (p > 0.05). Acoustic analysis showed a significant change in pre- and postoperative F0 values (p < 0.05), but not in jitter, jitter%, shimmer, shimmer%, and NHR (p > 0.05). Spectrographic analysis revealed significant postoperative changes in the F3 and F4 formants of consonants /m/, /n/, and vowel /i/ in the word /mini/. A significant correlation was found between postoperative changes in F3 and F4 formant values for consonants /m/ and /n/ with the VASchange value. For the NOSEchange value, a significant correlation was found only with the change in the F3 formant value for the consonant /m/.

CONCLUSION

Nasal surgeries, particularly septo-turbinoplasty, can influence voice timbre by modifying F3 and F4, which is of notable concern for professional voice users, such as singers and actors, due to the potential impact on the singer's formant cluster and overall vocal quality. Although it may not be appropriate to generalise for all rhinological surgeries, the significant changes in the F3 and F4 formants in a specific and refined patient group suggest that caution should be exercised in such surgeries, especially for professional voice users.

Maxillary sinus aeration analysis using computational fluid dynamics

The maxillary sinus aeration using the computational fluid dynamics (CFD) method based on individual adult patients’ computed tomography (CT) scans were analyzed. The analysis was based on CT images of 4 patients: one with normal nose anatomy and three with nasal septal deviation (NSD) and concha bullosa (CB). The CFD simulation was performed using the Reynolds-Average Simulation approach and turbulence closure based on linear eddy viscosity supplemented with the two-equation k-\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\omega$$\end{document}ω SST model. As a result, it was found that the lower part of NSD has the most significant impact on the airflow change within the maxillary sinuses compared to CB and the upper part of NSD. In a healthy nose, the airflow in the sinuses is continuous, while NSD and CB change this flow into pulsatile. Multiple changes in the direction of flow during one respiratory phase were observed. The flow intensity within the maxillary sinus opening is lower on the NSD side. The concept of vorticity measure is introduced to evaluate and compare various patients qualitatively. Typically, the lowest values of such measures are obtained for healthy airways and the highest for pathological changes in the nasal cavity.

Temporal and Permanent Changes Induced by Maxillary Sinus Lifting with Bone Grafts and Maxillary Functional Endoscopic Sinus Surgery in the Voice Characteristics-Systematic Review

Sinus surgery procedures such as sinus lifting with bone grafting or maxillary functional endoscopy surgery (FESS) can present different complications. The aims of this systematic review are to compile the post-operatory complications of sinus elevation with bone grafting and FESS including voice changes, and to elucidate if those changes are either permanent or temporary. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used, and the literature was exhaustively searched without time restrictions for randomized and non-randomized clinical studies, cohort studies (prospective and retrospective), and clinical case reports with ≥4 cases focused on sinus lift procedures with bone grafts and functional endoscopic maxillary sinus surgery. A total of 435 manuscripts were identified. After reading the abstracts, 101 articles were selected to be read in full. Twenty articles that fulfilled the inclusion criteria were included for analysis. Within the limitations of this systematic review, complications are frequent after sinus lifting with bone grafts and after FEES. Voice parameters are scarcely evaluated after sinus lifting with bone grafts and no voice changes are reported. The voice changes that occur after FESS include a decreased fundamental frequency, increased nasality, and nasalance, all of which are transitory.