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

  • Rhinology
  • Published:
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Abstract

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.

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References

  1. Mora R, Jankowska B, Dellepiane M et al (2009) Acoustic features of voice after septoplasty. Med Sci Monit 15:269–273

    Google Scholar 

  2. Han D, Xu W, Hu R et al (2012) Voice function following Han’s uvulopalatopharyngoplasty. J Laryngol Otol 126:47–51

    Article  CAS  PubMed  Google Scholar 

  3. Fleischer M, Pinkert S, Mattheus W et al (2015) Formant frequencies and bandwidths of the vocal tract transfer function are affected by the mechanical impedance of the vocal tract wall. Biomech Model Mechanobiol 14:719–733

    Article  PubMed  Google Scholar 

  4. OzbalKoc EA, Koc B, Ercan I, Kocak I, Tadihan E, Turgut S (2014) Effects of septoplasty on speech and voice. J Voice 28(3):393.e11–5

    Article  Google Scholar 

  5. Lee GS, Yang CC, Wang CP, Kuo TB (2005) Effect of nasal decongestion on voice spectrum of a nasal consonant-vowel. J Voice 19(1):71–77

    Article  PubMed  Google Scholar 

  6. Kim YH, Lee SH, Park CW et al (2013) Nasalance change after sinonasal surgery: analysis of voice after septoturbinoplasty and endoscopic sinus surgery. Am J Rhinol Allergy 27:67–70

    Article  PubMed  Google Scholar 

  7. Liapi A, Hirani S, Rubin J (2016) Changes in nasal resonance following septoplasty in adults: acoustic and perceptual characteristics. Logoped Phoniatr Vocol 41:93–100

    Article  PubMed  Google Scholar 

  8. Kim SD, Park HJ, Kim GH et al (2015) Changes and recovery of voice quality after sinonasal surgery. Eur Arch Otorhinolaryngol 272:2853–2859

    Article  PubMed  Google Scholar 

  9. Atan D, Ozcan KM, Gurbuz ABT et al (2016) The effect of septoplasty on voice performance in patients with severe and mild nasal septal deviation. J Craniofac Surg 27:1162–1164

    Article  PubMed  Google Scholar 

  10. Gulec S, Kulahli I, Ilhan M et al (2016) Effect of septoplasty on voice quality: a prospective-controlled trial. Clin Exp Otorhinolaryngol 9:238–243

    Article  PubMed  PubMed Central  Google Scholar 

  11. Yeğin Y, Çelik M, Şimşek BM, Akidil AÖ, Olgun B, Altıntaş A, Kayhan FT (2016) Assessment of effects of septoplasty on acoustic parameters of voice: a prospective clinical study Turk. Arch Otorhinolaryngol 54:146–149

    Article  Google Scholar 

  12. Subramaniam V, Yoonus R, Narra M (2015) Effects of septoplasty on the acoustic parameters of voice. Egypt J Ear Nose Throat Allied Sci 16:259–263

    Article  Google Scholar 

  13. Celik O, Boyaci Z, Yelken K, Atespare A, Celebi S, Koca O (2012) Septorhinoplasty with spreader grafts enhances perceived voice quality without affecting acoustic characteristics. J Voice 26(4):493–495

    Article  PubMed  Google Scholar 

  14. Hernández-García E, Moro-Velazquez L, González-Herranz R, Lara A, Godino-Llorente JI, Plaza G (2019) Effect of septoplasty on voice performance: nasalance and acoustic study. J Craniofac Surg 30(4):1000–1003

    Article  PubMed  Google Scholar 

  15. Amer HS, Elaassar AS, Anany AM, Quriba AS (2017) Nasalance Changes Following Various Endonasal Surgeries. Int Arch Otorhinolaryngol 21:110–114

    Article  PubMed  PubMed Central  Google Scholar 

  16. Thejaswi D, Alfred RM, D’Souza FP (2016) Effect of septoplasty on cepstral analysis of voice. Indian J Otolaryngol Head Neck Surg 68(3):289–293

    Article  CAS  PubMed  Google Scholar 

  17. Apaydın E, İkincioğulları A, Çolak M, Atan D, Ensari S, Dere HH (2019) The voice performance after septoplasty with surgical efficacy demonstrated through acoustic rhinometry and rhinomanometry. J Voice S0892–1997(18):30531–30539

    Google Scholar 

  18. Karakurt SE, Özcan KM, İkincioğulları A, Çetin MA, Özcan M, Dere HH (2020) Is nasal septum deviation severity a significant factor on voice in patients undergoing septoplasty? J Coll Physicians Surg Pak 30(3):287–291

    Article  PubMed  Google Scholar 

  19. Li HY, Wang PC, Hsu CY, Cheng ML, Liou CC, Chen NH (2005) Nasal resistance in patients with obstructive sleep apnea. ORL 67:70–74

    Article  PubMed  Google Scholar 

  20. Stewart MG, Witsell DL, Smith TL, Weaver EM, Yueh B, Hannley MT (2004) Development and validation of the Nasal Obstruction Symptom Evaluation (NOSE) scale. Otolaryngol Head Neck Surg 130(2):157–163

    Article  PubMed  Google Scholar 

  21. Okalidou A, Karathanasi A, Grigoraki E (2011) Nasalance norms in Greek adults. Clin Linguist Phon 25(8):671–688

    Article  PubMed  Google Scholar 

  22. Birkent H, Erol U, Ciyiltepe M, Eadie TL, Durmaz A, Tosun F (2009) Relationship between nasal cavity volume changes and nasalence. J Laryngol Otol 123:407–411

    Article  CAS  PubMed  Google Scholar 

  23. Clement P, Gordts F (2005) Consensus report on acoustic rhinometry and rhinomanometry. Rhinology 43:169–179

    CAS  PubMed  Google Scholar 

  24. Lachanas VA, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE (2014) Validation of the nasal obstruction symptom evaluation (NOSE) scale for Greek patients. Otolaryngol Head Neck Surg 151(5):819–823

    Article  PubMed  Google Scholar 

  25. Sinoff G, Ore L, Zlotogorsky D, Tamir A (1999) Short anxiety screening test—a brief instrument for detecting anxiety in the elderly. Int J Geriatr Psychiatry 14:1062–1071

    Article  CAS  PubMed  Google Scholar 

  26. Grammatikopoulos IA, Sinoff G, Alegakis A, Kounalakis D, Antonopoulou M, Lionis C (2010) The short anxiety screening test in Greek: translation and validation. Ann Gen Psychiatry 9(1):1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jacobson BH, Johnson A, Grywalski C et al (1997) The voice handicap index (VHI): development and validation. Am J Speech Lang Pathol 6:66–70

    Article  Google Scholar 

  28. Helidoni ME, Murry T, Moschandreas J, Lionis C, Printza A, Velegrakis GA (2010) Cross cultural adaptation and validation of the voice handicap index into Greek. J Voice 24(2):221–227

    Article  PubMed  Google Scholar 

  29. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    Article  PubMed  Google Scholar 

  30. Pegoraro-Krook MI, Dutka-Souza JCR, Williams WN, TelesMagalhães LC, Rossetto PC, Riski JE (2006) Effect of nasal decongestion on nasalence measures. Cleft Palate Craniofac J 43(03):289–294

    Article  PubMed  Google Scholar 

  31. Soneghet R, Santos RP, Behlau M, Habermann W, Friedrich G, Stammberger H (2012) Nasalance changes after functional endoscopic sinus surgery. J Voice 16:392–397

    Article  Google Scholar 

  32. Vishak S, Rajneesh SK, Vinay V, Mahesh BT, Manjula G, Jacqueline BF (2018) Voice analysis following turbinectomy in patients with hypertrophied inferior turbinate secondary to allergic and vasomotor rhinitis refractory to conservative treatment. Perspect Med Res 6(2):60–63

    Google Scholar 

  33. Borden GJ, Harris KS, Raphael LJ (2007) Acoustics. In: Raphael LJ (ed) Physiology, acoustics, and perception of speech. Lippincott Williams and Wilkins, Philadelphia, pp 31–53

    Google Scholar 

  34. Watterson T, Lewis KE, Ludlow JC, Ludlow PC (2008) The effect of nasal decongestion on nasal patency and nasalence scores in subjects with normal speech. Cleft Palate Craniofac J 45:620–627

    Article  PubMed  Google Scholar 

  35. Jiang RS, Huang HT (2006) Changes in nasal resonance after functional endoscopic sinus surgery. Am J Rhinol 20:432–437

    Article  PubMed  Google Scholar 

  36. Mayo R, Floyd LA, Warren DW, Dalston RM, Mayo CM (1996) Nasalance and nasal area values: cross-racial study. Cleft Palate Craniofac J 33:143–149

    Article  CAS  PubMed  Google Scholar 

  37. Litzaw LL, Dalston RM (1992) The effect of gender upon nasalence scores among normal adult speakers. J Commun Disord 25:55–64

    Article  CAS  PubMed  Google Scholar 

  38. Williams RG, Eccles R, Hutchings H (1990) The relationship between nasalence and nasal resistance to airflow. Acta Otolaryngol 110:443–449

    Article  CAS  PubMed  Google Scholar 

  39. Behlau M, Hogikyan ND, Gasparini G (2007) Quality of life and voice: study of a Brazilian population using the voice-related quality of life measure. Folia Phoniatr Logop 59(6):286–296

    Article  PubMed  Google Scholar 

  40. Murry T, Rosen CA (2000) Outcome measurements and quality of life in voice disorders. Otolaryngol Clin North Am 33:905–916

    Article  CAS  PubMed  Google Scholar 

  41. Behrman A, Shikowitz MJ, Dailey S (2002) The effect of upper airway surgery on voice. Otolaryngol Head Neck Surg 127:36–42

    Article  PubMed  Google Scholar 

  42. Park SK, Lee YS, Kang YA, Xu J, Rha KS, Kim YM (2018) The effects of uvulopalatal flap operation on speech nasalance and the acoustic parameters of the final nasal consonants. Auris Nasus Larynx 45(2):311–319

    Article  PubMed  Google Scholar 

  43. Valsamidis K, Titelis K, Karkos P, Markou K, Constantinidis J, Triaridis S (2019) Predictive factors of patients’ general quality of life after nasal septoplasty. Eur Arch Otorhinolaryngol 276(2):429–438

    Article  PubMed  Google Scholar 

  44. Van de Weijer J, Slis IH (1991) Nasaliteitsmeting met de nasometer. Logopedie Foniatrie 63:97–101

    Google Scholar 

  45. Litzaw LL, Dalston RM (1992) The effect of gender upon nasalance scores among normal adult speakers. J Commun Disord 25(1):55–64

    Article  CAS  PubMed  Google Scholar 

  46. Van Lierde KM, Wuyts FL, De Bodt M, Van Cauwenberge P (2001) Nasometric values for normal nasal resonance in the speech of young Flemish adults. Cleft Palate Craniofac J 38(2):112–118

    Article  PubMed  Google Scholar 

  47. Kavanagh ML, Fee EJ, Kalinowski J, Doyle PC, Leeper HA (1994) Nasometric values for three dialectal groups within the Atlantic Provinces of Canada. J Speech Lang Pathol Audiol 18:7–13

    Google Scholar 

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Correspondence to Stefanos Triaridis.

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Valsamidis, K., Printza, A., Constantinidis, J. et al. Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction. Eur Arch Otorhinolaryngol 279, 1899–1910 (2022). https://doi.org/10.1007/s00405-021-06937-9

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  • DOI: https://doi.org/10.1007/s00405-021-06937-9

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