Nasalance change after sinonasal surgery: analysis of voice after septoturbinoplasty and 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.

Changes in perception of pitch during vocal performance after three- and two-wall orbital decompression surgery

This case series presents 2 Caucasian females that underwent orbital decompression surgery for symptomatic exophthalmos and postoperatively developed a change in their perception of pitch during vocal performance. One patient went as far as to undergo voice lessons in attempt to regain her pre-operative pitch perception; however, the attempt was unsuccessful. We propose the etiology of this complication is anatomic changes within the ethmoid sinus. Temporary changes in nasalance have previously been reported with functional endoscopic sinus surgery literature, but this specific complication of change in pitch perception has not.

A voice and speech corpus of patients who underwent upper airway surgery in pre- and post-operative states

Many research articles have explored the impact of surgical interventions on voice and speech evaluations, but advances are limited by the lack of publicly accessible datasets. To address this, a comprehensive corpus of 107 Spanish Castilian speakers was recorded, including control speakers and patients who underwent upper airway surgeries such as Tonsillectomy, Functional Endoscopic Sinus Surgery, and Septoplasty. The dataset contains 3,800 audio files, averaging 35.51 ± 5.91 recordings per patient. This resource enables systematic investigation of the effects of upper respiratory tract surgery on voice and speech. Previous studies using this corpus have shown no relevant changes in key acoustic parameters for sustained vowel phonation, consistent with initial hypotheses. However, the analysis of speech recordings, particularly nasalised segments, remains open for further research. Additionally, this dataset facilitates the study of the impact of upper airway surgery on speaker recognition and identification methods, and testing of anti-spoofing methodologies for improved robustness.

Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps

Nasal polyps are associated with hyponasality. The effect of functional endoscopic sinus surgery (FESS) on voice quality has not been adequately investigated; therefore, this study developed objective and subjective measurements to compare nasal polyp patients pre- and postsurgery. An observational prospective study was conducted at Srinagarind Hospital, Khon Kaen University, Thailand. Bilateral nasal polyposis patients who underwent FESS between August 1, 2015 and August 1, 2017, were recruited. All participants were assessed for nasal polyp grade, nasometry, acoustic parameters, acoustic perception, and patient satisfaction before surgery and at the 1-, 3- and 6-month follow-ups. Forty-six patients, 29 males and 17 females (mean age 48.2 years ± 16.2 years), were enrolled. Mean nasometry scores were significantly improved at 1, 3 and 6 months after surgery (p < 0.05), whereas the acoustic parameters were not significantly different after surgery (p > 0.05). Overall acoustic perception, assessed with a set of words and sentences, showed significant improvement in hyponasality voice after surgery (p < 0.05), whereas GIRBAS showed no significant change after surgery in each parameter of perception (p > 0.05). Patient satisfaction with voice changes after surgery was high, with significantly increased mean scores between the 1- and 6-month follow-ups (p < 0.05). The results showed that FESS for nasal polyposis patients improved voice quality and patients' voice satisfaction ratings. Trial registration: This trial was registered at the Thai Clinical Trial Registry (TCTR20210324004).

Increased nasality of connected speech in patients underwent modified Lothrop procedure for refractory chronic rhinosinusitis: Cross-sectional and prospective study

BACKGROUND

The endoscopic modified Lothrop procedure (EMLP) is performed to create a large frontal neostium in patients who had failed previous frontal sinus surgeries. EMLP causes obvious changes in the volume and anatomy of the sinuses, which may cause a more significant change in nasality. This study aimed to evaluate the changes in nasalance in patients who underwent EMLP by comparing their preoperative nasalance to the established normative values and postoperative nasalance.

METHODS

This was a prospective study. Twenty-one patients diagnosed with refractory frontal sinusitis who were indicated to undergo EMLP were enrolled. One hundred one healthy participants were enrolled as norm references. The Nasometer II Model 6400 (KayPENTAX) was used to analyze the nasalance scores. Nasalance scores were tested before surgery and 1 and 3 months after the surgery.

RESULTS

The normative references of nasalance were (mean ± SD) 14.6% ± 6.7%, 39.4% ± 8.4%, and 55.8% ± 8.3% for the oral passage, oral-nasal passage, and nasal sentences, respectively. The mean nasalance scores pre-EMLP and 1 and 3 months post-EMLP were 23.2% ± 9.6%, 29.0% ± 9.3%, and 29.9% ± 0.4% for the oral passage; 48.7% ± 10.7%, 54.7% ± 7.7%, and 56.4% ± 7.2% for the oral-nasal passage; and 62.7% ± 10.9%, 69.8% ± 6.7%, and 70.7% ± 6.4% for the nasal sentences, respectively. Compared with the normative references, pre-EMLP nasalance was higher for all the three speech stimuli (t-test, p < 0.05). Post-EMLP nasalance also significantly increased for all the three stimuli at the 1- and 3-month follow-up visits (Paired t-test, p < 0.05).

CONCLUSION

EMLP has a short-term impact on resonance; however, long-term follow-up is required for further study.

The effect of functional endoscopic sinus surgery on nasal resonance

Background and objective

Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings.

Methods

The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2.

Results

In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua.

Conclusion

Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.

Nasality outcome in unilateral chronic rhinosinusitis following functional endoscopic sinus surgery

BACKGROUND/PURPOSE

In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS).

METHODS

A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease.

RESULTS

Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group.

CONCLUSION

Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.

Influence of Upper Airway Surgery on Voice and Speech Recognition

PURPOSE

Upper airway surgery comprises a set of techniques that modify the anatomy of the vocal tract, including tonsillectomy and septoplasty. The objective of this work is to study the changes in acoustic parameters and the effects on the identification or verification of the speaker through the speech produced after the vocal tract surgeries, comparing them with a control group.

METHODS

A prospective study was performed between January 2019 and June 2019 including. The final study sample consisted of 84 patients who met the inclusion criteria. Of these, 31 underwent septoplasty, 26 tonsillectomy patients, and 27 controls. Demographic data and GRBAS evaluation were statistically evaluated. Tests were taken before surgery, 2 weeks after surgery and 3 months later. Furthermore, to establish the equal error rate, the recording of patients' voices was made with a succeeding acoustic analysis and programmed identification of the speaker through machine learning systems.

RESULTS

A significant variance was observed in GRBAS, after surgery. Regarding acoustic parameters, a greater change was observed in the fundamental frequency at 2 weeks after surgery in the tonsillectomy group. Formants (F1-F3) and antiformants (AntiF1-AntiF3) changed in septoplasty group, not in tonsillectomy and control group at 3 months. When studying the impact of voice changes on the verification of the speaker through the speech, it was observed that there was a greater error in recognition in the tonsillectomy group at 2 weeks, coinciding with the results obtained in the rest of the parameters studied.

CONCLUSIONS

Results suggest that upper airway surgery produces modifications in the vocal tract affecting GRBAS, acoustic parameters, including formants and antiformants, producing an effect on verification of the speaker through the speech.

Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction

PURPOSE

The purpose of this study was to investigate the changes in voice nasality after septoplasty and turbinate hypertrophy reduction and to evaluate the effect of these changes on patients' voice-related quality of life.

METHODS

Sixty patients with nasal obstruction symptoms caused by septal deviation and inferior turbinate hypertrophy who underwent septoplasty and inferior turbinate hypertrophy reduction and 25 healthy controls were included. Active anterior rhinomanometry and acoustic rhinometry were utilized for the evaluation of nasal patency and nasometry was used for quantitative assessment of nasalance. All participants completed validated questionnaires for assessing nasal obstruction symptom severity, psychological status and the impact of voice performance on their quality of life preoperatively and 6 months after septoplasty.

RESULTS

Patients presented preoperatively statistically significantly lower nasalance scores and higher VHI scores than controls (p < 0.05). Septoplasty and inferior turbinate hypertrophy reduction led to improvement of nasalance for the nasal text and the physical subscale of the VHI scores. Postoperatively, there were no statistically significant differences in nasalance and VHI scores between patients and controls. Significant correlations were found only for the baseline and the postoperative nasalance scores for the nasal text and the total nasal cavity volume (p < 0.05). Postoperatively, patients who presented significant improvement of nasal obstruction symptoms and resolution of stress levels were more likely to positively evaluate the impact of their voice quality on their daily life (OR: 2.32, 95% CI 1.08-5.15, p = 0.041 and OR: 3.06, 95% CI 1.15-7.04, p = 0.038, respectively).

CONCLUSION

Septoplasty and inferior turbinate hypertrophy reduction may increase the nasal resonance, but in the long term, this change appears not to be significant enough. The severity of nasal obstruction symptoms and psychological status mainly affect the patients' perceptual assessment regarding the effect of voice performance on their quality of life.

Does Nasal Surgery Affect Voice Outcomes? A Systematic Review with Meta-Analyses

OBJECTIVES

Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality.

METHODS

Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements.

RESULTS

Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, (P < .01) 1 month postoperatively; there was no significant difference in nasalance at 6 months postoperatively. All other variables analyzed revealed no statistically significant differences. Five of nine studies showed majority of patients did not notice subjective change in voice after surgery, but with high heterogeneity of measurements.

CONCLUSIONS

There may be a short-term increase in nasalance that resolves at longer follow-up, but there seem to be no other objective changes in voice. There may be subjective changes after surgery, but require further study to evaluate.

Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis

PURPOSE

Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL.

METHODS

Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups.

RESULTS

All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P < 0.001). The rate of soft tissue densities within the frontal and sphenoid sinuses were noted in 26.8% and 17.1% of patients in the ESPAL group, compared to 83.3% and 83.3% of patients in the EAL group (P = 0.013 and P = 0.003, respectively).

CONCLUSION

PNS CT might be useful for predicting EA bleeding in patients with refractory epistaxis requiring surgical hemostasis.

Objective and subjective changes in voice after endoscopic sinus surgeries in patients with and without nasal polyps

BACKGROUND

Many studies have looked at the effect of functional endoscopic sinus surgeries (FESS) on nasalance, nasal consonant and nasalized vowels. Only two studies investigated the effect of FESS on vocal sound quality and have not found statistically significant changes before and after operations. The aim of this study was to examine the short-term and long-term objective and subjective changes in the vocal quality of patients after FESS, comparing patients with and without nasal polyps.

METHODS

Sixteen patients were recruited for voice analysis during pre-operative, within two weeks and at least three months post-operatively. Subjective questionnaire was used to assess perception of voice changes.

RESULTS

There were no statistically significant changes in the acoustic parameters of patients with nasal polyposis. In patients with CRS without polyps, there was a statistically significant increase in fundamental frequency (F₀) in nasal sound during early follow up. The changes in soft phonation index (SPI) values between the two groups were statistically significant during early follow-ups. Only patients with nasal polyposis perceived a subjective change in their voice post-operatively.

CONCLUSIONS

Clinicians should inform all patients, especially voice professionals about the possible effects of endoscopic sinus surgeries on their voice quality.

Effect of Septoplasty On Voice Performance: Nasalance and Acoustic Study

BACKGROUND

Septoplasty is a surgical technique for the correction of the nasal septum that may alter the vocal tract. The aim of our study is to assess whether this technique modifies nasalance and acoustic parameters, and their clinical implications in voice perception.

METHODOLOGY

A prospective study was performed between January 2017 and June 2017 including 2 groups of patients: those undergoing septoplasty, and a control group. Subjective nasality questionnaire, objective nasalance with nasometer, and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) assessment were statistically analysed. In addition, a recording of patients' voices was made with a subsequent acoustic analysis. Samples were taken: pre-surgically, 2 weeks after surgery and after 3 months.

RESULTS

After septoplasty, a significant difference was observed in GRBAS, nasality questionnaire and nasometer nasalance, when compared with the control group. As for the acoustic analysis, no differences were observed in most parameters (F0, Jitter, Shimmer, HNR, NHR, Formants F1-F3), except for the antiF3 antiformant, which showed significant changes in all the vowels studied.

CONCLUSIONS

Septoplasty can produce changes in the vocal tract, with an increase in initial nasalance but with subsequent normalization. Besides, minor changes were found in the acoustic analysis but with no clinical relevance.

The Effects of Endoscopic Sinus Surgery on Voice Characteristics in Chronic Rhinosinusitis Patients

Objectives:

Functional endoscopic sinus surgery (FESS) is a standard treatment modality for patients with chronic rhinosinusitis (CRS) who have failed appropriate medical therapy. However, FESS entails modification of the upper airway tract that may alter phonatory resonance and produce voice changes. The effects of FESS on postoperative voice characteristics in patients with CRS have yet to be quantitatively assessed.

Methods:

Patients with severe CRS who underwent FESS at a tertiary care referral center between May and October 2017 were prospectively enrolled. The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) and the Voice Handicap Index (VHI) were used to quantitatively evaluate voice characteristics and quality of life, respectively. Preoperative and postoperative CAPE-V and VHI scores were compared with postoperative scores for each patient. Sino-Nasal Outcome Test (SNOT-22) scores were also obtained to assess changes in patient symptoms.

Results:

18 CRS patients undergoing FESS were enrolled. The average preoperative Lund-Mackay score was 14, indicating baseline severe CRS. Postoperative assessments demonstrated a statistically significant decrease in CAPE-V (45-27, p = .005) and VHI (10-4.7, p < .001) scores. These correlated with a statistically significant decrease in SNOT-22 scores (42-13, p < .001).

Conclusions:

Patients with CRS experience a significant improvement in voice characteristics and vocal quality of life following FESS. Furthermore, this appears to correlate with a significant decrease in self-reported disease severity. These findings may augment the discussion of potential benefits of FESS to a new potential domain for voice quality.

Effect of Functional Endoscopic Sinus Surgery on Voice and Speech Recognition

OBJECTIVE

Functional Endoscopic Sinus Surgery (FESS) is the surgery of choice for nasal polyposis and chronic rhinosinusitis. The aim of our study is to assess the influence of this surgery in the acoustic parameters of voice, and their implications in the systems of identification or verification of the speaker through the speech.

MATERIAL AND METHODS

A prospective study was performed between January 2017 and June 2017 including two groups of patients: those undergoing FESS, and a control group. Demographic data and GRBAS assessment were statistically analyzed. In addition, a recording of patients' voices was made with a subsequent acoustic analysis and automatic identification of the speaker through machine learning systems, establishing the equal error rate. Samples were taken before surgery, 2 weeks after surgery and 3 months later.

RESULTS

After FESS, a significant difference was observed in Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS). Besides, acoustic analysis showed a significance decrease in fundamental frequency (F0), when compared with the control group. For the automatic identification of the speaker through computer systems, we found that the equal error rate is higher in the FESS group.

CONCLUSIONS

Results suggest that FESS produce a decrease of F0 and changes in the vocal tract that derive in an increase in the error of recognition of the speaker in FESS patients.

Predictive factors of patients' general quality of life after nasal septoplasty

PURPOSE

Although septoplasty is considered to be the definitive treatment of septal deviation and is associated with an increase of nasal patency, patients are not always satisfied with the surgical outcome as assessed by its effect on their general Quality of Life (QOL).The aim of this study was to identify the predictive factors that influence the patients' QOL after surgery.

METHODS

60 patients with nasal obstruction and septal deviation were enrolled in this prospective study, and they all completed the follow-up survey of 6 postoperative months. Symptom severity (Nasal Obstruction Symptom Evaluation-NOSE, Sino nasal outcome test 22-SNOT-22), sleep quality (Epworth Sleepiness Scale-ESS), olfactory function (Threshold Discrimination Identification-TDI score), voice quality (Nasalance score and Voice Handicap Index-VHI), stress (SQ test) and emotional status (Beck Depression Index-BDI) were evaluated as predictive factors of patients' QOL (Glasgow Benefit Inventory-GBI) postoperatively. We also analyzed age, gender, smoking, socioeconomic status, type of septal deviation and changes of nasal patency (with the use of rhinomanometry, acoustic rhinometry, and peak nasal inspiratory flow).

RESULTS

From all the analyzed parameters, the nasal obstruction symptom severity, the sleep quality, and stress levels were only significantly associated with patients' overall QOL (p < 0.05; univariate analysis). However, on multiple regression, positive changes in NOSE score (OR 15.09, 95% CI 1.47-22.64, p < 0.05) and SQ test (OR 4, 95% CI 1.12-14.3, p < 0.05) were only related with higher likelihood of participants' QOL improvement after surgery.

CONCLUSIONS

Thorough preoperative evaluation of the symptom severity and stress levels is critical as these two factors are predictive of patient's satisfaction after septoplasty.

Clinical application of nasometry in patients with nasal obstruction

The purpose of this case-control study is to report on the clinical application of nasometry as a diagnostic tool in patients with the symptom of nasal obstruction compared with subjects with no history of nasal obstruction. Thirty-eight adult patients (mean age: 28.1 years) complaining of nasal obstruction were enrolled in the study, and another group of 38 adults (mean age: 25.9 years) with no history of nasal obstruction served as controls. Demographic data, including age and sex, were collected. Patients were asked to read three passages; the Zoo passage, the Rainbow passage, and nasal sentences. Nasalance scores were reported on all subjects using a Nasometer II instrument. The control and patient groups each included 22 men and 16 women. No statistically significant difference in nasalance score was found between the study group and the control group in any of the Zoo passage, Rainbow passage and nasal sentences. We conclude that nasometry has limited value in the objective assessment of nasal obstruction as a symptom, which we attribute to nasal obstruction's not always reflecting the volume and pressure in the nasal cavity.

Effects of changes in nasal volume on voice in patients after endoscopic endonasal transsphenoidal surgery

OBJECTIVE

To investigate a potential correlation between changes in voice and changes in nasal volume.

METHODS

The endoscopic endonasal transsphenoidal approach (EETSA) was performed on 120 patients between February 2009 and August 2016 by using the bilateral modified nasoseptal rescue flaps method. All the patients were subjected to pre- and postoperative paranasal computed tomography (CT) and voice evaluations by using acoustic analyses, a nasometer to measure the nasalance, and determination of the voice handicap index (VHI). Paranasal CT and the medical image processing software were used to calculate changes in nasal cavity volume in three nasal sections.

RESULTS

Enlargement of the nasal cavity after surgery was evident in all three areas (anteronasal, p < 0.001; midnasal, p = 0.005; postnasal, p = 0.025). In addition, EETSA resulted in significantly higher mean nasalance scores for the oronasal passage (p < 0.001) and nasal passage (p < 0.001); more frequency perturbation (jitter) (p < 0.001) and amplitude perturbation (shimmer) (p < 0.001); and higher grade, roughness, breathiness, asthenia, and strain scores (p < 0.001), and VHI (p = 0.01). However, only changes in the nasal volume after EETSA correlated with postnasal hypernasality (r = 0.2; p = 0.029).

CONCLUSION

Although changes in nasal volume, voice, and speech may develop after EETSA, we found that changes in nasal volume were not correlated with changes in any voice-quality measure. However, the postnasal cavity was the region most dramatically affected by EETSA, and postnasal volume changes after surgery may be associated with hypernasal speech.

Nasalance Changes Following Various Endonasal Surgeries

Introduction There is change in nasalance post endonasal surgery which is not permanent.

Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries.

Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery.

Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively.

Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.

Hypernasality after using the endoscopic endonasal transsphenoidal approach for skull base tumors

OBJECTIVES/HYPOTHESIS

The increasing number of endoscopic endonasal transsphenoidal approaches (EETSA) has resulted in several sinonasal complications, including voice changes. Here, we compared preoperative and postoperative voice changes according to age.

METHODS

We retrospectively reviewed the medical records. Patients were divided into the following three groups according to age: ≤ 30 years, 31 to 60 years, and ≥ 60 years. Patients underwent preoperative voice evaluation using acoustic analysis, a nasometer, and the voice handicap index (VHI). A nasometer was used to measure the nasalance scores. The subjects read or repeated three speech stimuli. For each stimulus, mean nasalance scores were obtained and age dependence was analyzed. Repeat testing was performed 6 months postoperatively.

RESULTS

One hundred and seventy patients who underwent binostril four-hand EETSA with a bilateral modified rescue flap were included in this study. Mean nasalance scores for the oral passage, oronasal passage, and nasal passage--as well as mean jitter scores, shimmer scores, and VHI--were significantly increased in all of the EETSA patients (P < 0.05 for all). Mean nasalance scores for the nasal sentences were significantly increased in the ≤ 30 age group (all, P < 0.05). Scores for the oronasal passage and nasal passage were significantly increased in the 31 to 60 age group (all, P < 0.05). Scores for the oronasal passage, nasal passage, jitter, and shimmer were significantly increased in the > 60 age group (all, P < 0.05).

CONCLUSIONS

Endoscopic endonasal transsphenoidal approaches might contribute to voice changes. In addition, older age might produce hypernasality and roughness after EETSA. Patients who plan to undergo EETSA should be informed that their voice may change after the operation.

LEVEL OF EVIDENCE

4.

Changes in nasal resonance following septoplasty in adults: Acoustic and perceptual characteristics

OBJECTIVES

Patients undergoing surgery for a deviated nasal septum (septoplasty) often report that their voice sounds different or less hyponasal. However, such a relationship between septoplasty and vocal resonance remains without scientific evidence. The purpose of this work is to investigate whether nasal septal surgery has any effect on nasal resonance, both in terms of objective measurements and patient perception.

METHODS

The research carried out was a prospective case-control study. We recruited patients who underwent septoplasty (study group) and healthy volunteers (control group). We obtained voice recordings of the nasal consonant /m/ pre- and four weeks postoperatively and twice at similar time intervals in the control group. We investigated objective changes by means of acoustic analysis of the voice recordings and calculated the total amount of acoustic energy in different bandwidths on a wide-band spectrogram. We also utilized a questionnaire to explore patient perception.

RESULTS

A total of 34 participants entered the study. ANOVA testing revealed significant changes in average total acoustic energy, phlegm, and throat dryness postoperatively. Regarding patient perception, a considerable number of our patients felt that their voice had changed for the better upon direct questioning. However, statistical analysis of the questionnaire items related to nasality of voice did not show a significant change.

CONCLUSIONS

In this study it has been demonstrated that surgical correction of septal deviation causes significant spectrographic changes. In particular it causes changes in the average total acoustic energy during the production of a nasal consonant. A considerable number of our patients reported change in their vocal resonance for the better. We recommend that patients be advised that their voice may sound different after surgery, or less hyponasal.

Effect of voice training in the voice rehabilitation of patients with vocal cord polyps after surgery

The objective of the present study was to determine the effect of voice training on the vocal rehabilitation of patients with vocal cords polyps following phonomicrosurgery. A total of 60 cases of vocal cord polyps treated by laser phonomicrosurgery were randomly divided into training and control groups with 30 cases in each group. The patients were treated with laser phonomicrosurgery, routine postoperative treatment and nursing. The training group were additionally treated with vocal training, including relaxation training, breathing training, basic pronunciation training, chewing voice training and tone sandhi pronunciation training, and attention was paid to the training steps. Subjective and objective voice evaluations of the two groups were compared three months after the surgery and the differences between groups were statistically significant (P<0.05). Voice training may significantly improve the postoperative voice quality of patients with vocal cord polyps and support rehabilitation.