Effects of adenotonsillectomy on speech spectrum in children

Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta-Analysis

OBJECTIVE

Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy.

DATA SOURCES

The PubMed, Medline, EMBASE, and Cochrane databases.

REVIEW METHODS

The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire.

RESULTS

Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery.

CONCLUSIONS

This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538-2550, 2024.

Effect of Adenotonsillectomy on Spectral and Acoustic Characteristics

Acoustic analysis and perceptual analysis has been extensively used to assess the speech and voice among individual with voice disorders. These methods provide objective, quantitative and precise information on the speech and voice characteristics in any given disorder and help in monitoring any recovery, deterioration, or improvement in an individual's speech and also differentiate between normal and abnormal speech and voice characteristics. The present study was carried out to investigate the spectral characteristics (formant frequency parameters and formant centralization ratios) and voice characteristics (Acoustic parameters of voice) changes in individuals following adenotonsillectomy. A total of 34 participants participated in the study with a history of adenotonsillar hypertrophy. Spectral and acoustic voice parameters were analyzed across the three-time domains, before surgery (T0), 30 days (T1), and 90 days (T2) after surgery. Data was analyzed statistically using the SPSS software version-28.0.0.0. Descriptive statistics were used to find the mean and standard deviation. Repeated measures of ANOVA were used to compare the pre and post-experimental measures for spectral and acoustic, voice parameters. The derived parameter of acoustic vowel space (formant centralization ratio 3) was compared across three conditions timelines. The results revealed that acoustic vowel space measure and formant frequency measures were significantly increased in pre and post-operative conditions across the three timelines. A significant difference was obtained across the acoustic parameters across the time domains. Adenotonsillectomy has been proved to be an efficient surgical procedure in treating children with chronic adenotonsillitis. The results obtained have indicated an overall improvement in the spectral and acoustic voice parameters thereby highlighting the need for adenotonsillectomy at the right time and at the right age.

Effects of Adenotonsillectomy on Vocal Function

INTRODUCTION

Correct breathing is a fundamental condition for adequate vocal production. Respiratory dynamics are able to modify the growth of facial mass and lingual posture, i.e., of the skull, the mandibular one. For this reason, infant mouth breathing can cause hoarseness.

MATERIALS AND METHODS

We evaluated the actual changes in the characteristics of the voice and articulation of language in a group of subjects affected by adenotonsillar hypertrophy (grade 3-4), with frequent episodes of pharyngo-tonsillitis who underwent adenotonsillectomy. Our study included 20 children-10 boys and 10 girls-aged 4 to 11 years who had adenotonsillar hypertrophy and pharyngotonsillitis episodes exceeding 5-6 per year in the previous 2 years. The control group (Group B) included 20 children-10 boys and 10 girls-aged 4 to 11 years (average age of 6.4 years) who had not undergone surgery and shared the same degree of adenotonsillar hypertrophy as those in Group A but who did not experience recurrent pharyngotonsillitis episodes.

DISCUSSION

The hypertrophy of adenoids and tonsils significantly impacted breathing, vocal function, and speech articulation. All this is responsible for a state of tension in the neck muscles, which at the level of the vocal tract causes hoarseness. The changes objectively observed in our study in the pre- and post-operative phase demonstrate how adenotonsillar hypertrophy is responsible for an increase in resistance to the passage of air at the glottic level.

CONCLUSIONS

For this reason, adenotonsillectomy has an impact on recurrent infections and can also lead to an improvement in speech, breathing, and posture.

Changes in Acoustic Aspects of Vocal Function in Children After Adenotonsillectomy

BACKGROUND

Adenotonsillectomy is one of the most common pediatric surgical procedures. Postoperative voice changes are a very common concern among patient's parents. Therefore, the aim of this study is to analyze acoustic voice parameters after adenotonsillectomy, tonsillectomy, and adenoidectomy in pediatric patients in a tertiary referral academic center.

PATIENTS AND METHODS

All pediatric patients undergoing an adenotonsillectomy, tonsillectomy or adenoidectomy in a single center from 2002 to 2018 were included in the study. Change of fundamental frequency, jitter, shimmer, and harmonic-noise ratio at first, seventh and 30th postoperative day compared to preoperative values were the primary outcome parameters. Statistical analysis was performed using repeated measures analysis of variance model.

RESULTS

A total of 1258 patients were included in the study. The mean age of patients at the time of surgery was 8.3 years (range 3.0-18.0 years). Around 698 were male (55.5%) and 560 female (44.5%). The values of fundamental frequency increased significantly after the first and seventh postoperative day (P = 0.001 both) but normalized 1 month after surgery (P = 0.962). At the first postoperative month, values of jitter and shimmer decreased significantly (P = 0.005 and P = 0.002, respectively). Measurements of harmonic-noise ratio revealed a significant increase 30 days after surgery (P = 0.004).

CONCLUSION

Statistically significant differences in objective voice parameters within the first postoperative month after tonsillectomy, adenoidectomy, and adenotonsillectomy were observed. The fundamental frequency returned to normal 1 month after surgery. These findings can contribute in soothing the concerns of parents regarding postoperative voice changes.

Adenoidectomy and persistent velopharyngeal insufficiency: Considerations, risk factors, and treatment

IMPORTANCE

Persistent velopharyngeal insufficiency (VPI) is a rare but well-recognized complication of adenoidectomy. VPI can have a significant impact on the communication of a child.

OBJECTIVE

To describe the pathophysiology of post-adenoidectomy VPI, identify its associated risk factors, and illustrate the techniques used to treat the entity.

EVIDENCE REVIEW

A search of English or translated English articles concerning adenoidectomy, partial adenoidectomy, superior adenoidectomy; and velopharyngeal insufficiency, speech and voice from 1980 to 2021 was performed using Pubmed and Embase. Data from prospective and retrospective studies and their relevant references were pooled.

RESULTS

By objective measures, hypernasality is noted in many pediatric patients post-adenoidectomy, but this typically resolves in 3-6 months. Risk factors for the development of post-adenoidectomy VPI include low birth weight, family history of hypernasality, and history of speech problems or nasal regurgitation. The cleft palate, submucous cleft palate, poor palate mobility, and a deep pharynx may indicate susceptibility to VPI. Speech therapy is successful in up to 50% of patients, while surgical intervention may be tailored based on the diagnostic evaluation of the velopharynx with videofluoroscopy or nasoendoscopy.

CONCLUSION

We present a comprehensive review of the literature on the pathophysiology, risk factors, and treatment of post-adenoidectomy VPI. We hope to bring awareness to the factors that can lead to a rare but potentially devastating complication in one of the most common procedures performed by Otolaryngologists.

Potential Effects of Rhinoplasty on Voice in Professional Voice Users

BACKGROUND AND AIM

Surgical procedures involving the manipulation of the airway structure have the potential to affect the quality of voice by changing the resonance properties. Regarding this, the present study was conducted to investigate the effect of rhinoplasty on the voice of professional voice users.

METHODS AND MATERIALS

This cohort study was conducted on 30 professional voice users. For the purpose of the study, the patients completed the Voice Handicap Index (VHI). In addition, they were subjected to voice analysis that included the measurement of nasality in speech production (i.e., nasalance), using the nasometer II. Computerized speech lab was also utilized to examine vowels /e/ and /a/, each of which was sustained for 5 sec by the participants.

RESULTS

The mean VHI scores were 8.5 ± 1.98 and 7.36 ± 1.71 before and after the surgery, respectively, indicating no significant difference between the two investigated stages (Z = - 0.53, P = 0.59). However, there was a significant difference between the patients with and without preoperative obstruction in terms of the VHI score (χ²= 11.06, P = 0.004). With regard to orality, it had the mean values of 16.86 ± 7.45 and 15.22 ± 7.37 before and after the surgery, respectively. Furthermore, the mean values of nasality at the pre- and post-operation stages were 59.42 ± 6.04 and 56.28 ± 10.07, respectively. The comparison between the pre- and post-surgical orality and nasality revealed no significant difference (t = 1.226, P = 0.23 and t = 0.93, P = 0.36, respectively).

CONCLUSION

Although rhinoplasty is supposed to affect voice and vocal resonation, the induced changes are not problematic for the professional voice users.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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.

Prevalence of Dysphonia in Children with Adenotonsillar Problems and the Impact of Surgery on Voice

OBJECTIVE/HYPOTHESIS

Adenotonsillar problems might affect the voices of patients with pediatric dysphonia, which is very common. This study aimed to evaluate the prevalence of dysphonia in patients with adenotonsillar problems and to demonstrate the impact of tonsillectomy and adenoidectomy (T & A) on their voice postoperatively.

STUDY DESIGN

Single-institution retrospective study.

METHODS

Subjects were recruited from those children admitted for the purpose of T & A, and all underwent the auditory-perceptual assessment by speech therapists preoperatively. If children demonstrated scores >2 in the G parameter, we performed subjective (pediatric voice handicap index [pVHI], severity, talkativeness scale) and objective (Multi-Dimensional Voice Program) voice analyses preoperatively and 1 and 3 months postoperatively.

RESULTS

Among the 1,197 patients, 91 (7.6%) patients showed dysphonia with a score >2 in the G parameter preoperatively. The follow-up voice analysis was completed in 51 and 22 patients after 1 and 3 months, respectively. Although there were no significant differences in the amount of speech preoperatively and postoperatively, the average visual analog scale score for dysphonia severity was significantly decreased at postoperative 1 month and postoperative 3 months. The average total pVHI score, jitter, shimmer, noise-to-harmonic ratio, and soft phonation index were significantly decreased at 1 and 3 months postoperatively. Subjective scores given by parents did not correlate with the acoustic parameters; however, the postoperative subjective parameters were significantly correlated with objective parameters.

CONCLUSIONS

Voice problems were significantly improved after T & A in the short term and long term. In those with pediatric dysphonia, decreased mouth breathing and compliance with vocal hygiene would be helpful for voice improvement.

LEVEL OF EVIDENCE

4 Laryngoscope, 2021.

Surgical and therapeutic advances in the management of voice problems in children and young people

PURPOSE OF REVIEW

The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments.

RECENT FINDINGS

It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong.

SUMMARY

Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.

Voice Analysis in Post Tonsillectomy Patients

The main aim of this study was to analyse the change in voice in terms of acoustic parameters and its perceptual impact in patients who have undergone tonsillectomy. A prospective study was conducted in our institution-JSS Hospital and JSS institute of speech and hearing, Mysore for a duration of 1 year (December 2015-December 2016). 50 post tonsillectomy cases were selected randomly and subjected to acoustic analysis. It was inferred that situation of vocal analysis and assessment for the vowels 'a', 'i' and 'u' under the categories hoarse, harsh and breathy remain more or less the same during preoperative stages, first preoperative follow up and the second post operative follow up. It was concluded that tonsillectomy did not appear to change the acoustic features of vowels remarkably. It was assumed that the subject may adjust the shape of the vocal tract to produce consistent speech sound after surgery using auditory feedback.

The effect of hypertrophied tonsils on the velopharyngeal function in children with normal palate

OBJECTIVE

Tonsillar hypertrophy may affect velopharyngeal closure and speech resonance. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with normal palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.

METHODS

Eighty seven children with hypertrophied tonsils and normal palate were subjected to tonsillectomy for indications other than speech problems. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech (APA) and nasometric assessment of nasalance was measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.

RESULTS

Thirteen patients were excluded from the study because of associated adenoid hypertrophy. The mean baseline of APA scores showed insignificant changes postoperatively. However, significant postoperative changes of nasometric parameters were detected, and the overall postoperative nasalance score was improved for nasal and oral sentences. Also, improvement of velopharyngeal closure was observed postoperatively with accession of palatal mobility and significant increase in coronal closure pattern.

CONCLUSION

hypertrophied tonsils may impair velopharyngeal function in children with normal palate by hindering palatal elevation. Tonsillectomy is a beneficial procedure for such patients as it can improve the velopharyngeal closure and speech resonance.

Acoustic Characteristics in Epiglottic Cyst

OBJECTIVE

The purpose of this study was to analyze the acoustic characteristics associated with alternation deformation of the vocal tract due to large epiglottic cyst, and to confirm the relation between the anatomical change and resonant function of the vocal tract.

METHODS

Eight men with epiglottic cyst were enrolled in this study. The jitter, shimmer, noise-to-harmonic ratio, and first two formants were analyzed in vowels /a:/, /e:/, /i:/, /o:/, and /u:/. These values were analyzed before and after laryngeal microsurgery.

RESULTS

The F1 value of /a:/ was significantly raised after surgery. Significant differences of formant frequencies in other vowels, jitter, shimmer, and noise-to-harmonic ratio were not presented.

CONCLUSION

The results of this study could be used to analyze changes in the resonance of vocal tracts due to the epiglottic cysts.

Impact of adenotonsillectomy on vocal emission in children

Introduction

Adenotonsillectomy is the most common surgery performed by otolaryngologists in pediatric age, and one of the most frequently asked questions about the postoperative period is whether there is a potential for change in vocal pattern of these children.

Objective

To evaluate the impact of adenotonsillectomy in the voice emission pattern of children with hypertrophy of palatine and pharyngeal tonsils.

Methods

This is a prospective study in which we carried out perceptual auditory assessments and acoustic analysis of 26 children with adenotonsillar hypertrophy at three time points: before surgery, one month and three months after surgery. The following acoustic parameters were estimated using the Praat software: fundamental frequency, jitter, shimmer, and harmonic–noise ratio.

Results

A statistically significant change was found between shimmer and harmonic–noise ratio during vowel /u/ production between the preoperative and 1st month postoperative time points. No significant differences were detected for acoustic parameters between preoperative analysis and that of the 3rd month post-operation.

Conclusion

Transient changes in acoustic parameters occur in children with adenotonsillar hypertrophy submitted to adenotonsillectomy, progressing to normalization in the 3rd postoperative month.

Uso do programa MDVP em diferentes contextos: revisão de literatura

Resumo:Este estudo tem como objetivo descrever, a partir de revisão de literatura, a confiabilidade da análise acústica utilizando o Multi Dimensional Voice Program,comparação de suas medidas com outros programas de análise acústica; caracterização de vozes de diferentes grupos; e sua utilização para verificar os efeitos e eficácia de diferentes procedimentos terapêuticos. Realizou-se levantamento bibliográfico que priorizaram estudos dos últimos cinco anos, incluindo-se artigos cujo objetivo estivesse de acordo com o interesse da presente revisão. A pesquisa foi realizada nos bancos de dados das bases Lilacs, BIREME, PubMed, MedLine, Scielo e Google Schoolar, por meio dos descritores acoustic, speech acoustics e voice. As medidas mais utilizadas são frequência fundamental, jitter, shimmer e proporção harmônico-ruído. As medidas de tremor não apresentam boa confiabilidade. As medidas mais consistentes que apresentam alta concordância com outros programas de análise acústica são as relacionadas com a frequência fundamental. Diversos estudos buscam caracterizar diferentes tipos de vozes tais como as de sujeitos sem alterações vocais de ambos os sexos, buscando estabelecer parâmetro de normalidade para diferentes grupos populacionais. Além disso, alguns estudos caracterizam vozes com diferentes distúrbios. A análise acústica é um recurso objetivo e necessário na avaliação de pacientes com distúrbio vocal e, principalmente, na comparação de diversos tipos de tratamento.

Effect of Septoplasty on Cepstral Analysis of Voice

Resonance change is a common clinical symptom in individuals with deviated nasal septum. Often this anatomical deficit is surgically treated by septoplasty. Therefore monitoring resonance changes using acoustical tools is vital. Hence, the study investigated cepstral measure differences in subjects with deviated nasal septum compared to normals. A case-control study design involving 20 subjects within 18-40 years divided into Group I of 10 subjects with deviated nasal septum (DNS) and Group II of 10 normal subjects participated. All the subjects sustained nasalized vowel /ã/ at 10 cm mouth-microphone distance for minimum of 5 seconds. For Group I, voice sample was recorded in 2 conditions, 2 days pre-septoplasty and 1 month post-septoplasty. Cepstral peak prominence (CPP) and smooth cepstral peak prominence (CPPS) values was extracted using the Hillenbrand algorithm. Mean values revealed increased CPP and CPPS measure post-septoplasty when compared to pre-septoplasty. ANOVA showed statistically significant difference only for CPPS at p = 0.00. The higher cepstral values of post-septoplasty is due to widened nasal passage that leads to increased nasal volume, decreased acoustic damping and increased nasal patency. These changes in supraglottic chambers will result in a better acoustic space for good resonance. However, the CPPS values were not similar to normal subjects because of scarring or incomplete recovery of the outer mucosal layer of the nasal tract. Thus, we can conclude that cepstral analysis is a sensitive tool to detect resonance changes in the nasal patency.

Evaluation of pediatric voice handicap index and pediatric voice related quality of life before and after adenotonsillectomy in pediatric population

OBJECTIVE

To study changes in Pediatric Voice Handicap Index (PVHI) and Pediatric Voice Related Quality of Life (PVRQOL) before and after adenotonsillectomy in short term follow up.

METHODS

Quasi-experimental (before and after study). Eighty-six children aged 3-13 years (58 boys, 28 girls) with adenotonsillar problems (whether with obstructive or infectious surgical indications) who were admitted for adenotonsillectomy procedure. Parents of children were asked to complete PVHI and PVRQOL questionnaires prior to surgery and 1 month after it.

RESULTS

Reliability of the PVRQOL and PVHI was established by evaluation of Cronbach α value. Cronbach α for PVHI was 0.92 and for PVRQOL it was 0.83. Preoperative values for the PVHI were: mean±SD; 14.39±14.65. Preoperative values for the PVRQOL were: mean±SD; 92.60±10.82. PVHI showed significant improvement after surgery: mean±SD; 2.93±6.98 (P<0.001). Postoperative PVRQOL had a significant improvement: mean±SD; 98.11±5.82 (P<0.001).

CONCLUSION

Adenotonsillectomy improved PVHI and PVRQOL scores in children with adenotonsillar problems, regardless of obstructive or infectious surgical indications.

Aspects of stomatognathic system before and after adenotonsillectomy

PURPOSE

To verify the speech therapy aspects of the stomatognathic system, including phonoarticulatory structures (lips, tongue, and soft palate) and swallowing, respiratory, speech, and phonation (vocal quality and resonance) functions, before and after undergoing adenotonsillectomy.

METHODS

The study included 22 children, 17 males and 5 females, aged between 5 and 10 years, suffering from hypertrophy of palatine and adenoid tonsils, with surgical indication for adenotonsillectomy and with no previous speech therapy. The speech-language pathology evaluation was performed before surgery and during the period between 1 and 6 months after adenotonsillectomy. It consisted of an evaluation of structures (lips, tongue, and soft palate) and of swallowing (liquid), respiration (mode), speech, and phonation (voice quality and resonance) functions. To evaluate vocal quality and resonance, 15 participants with the postoperative evaluation carried out in a period from 1 to 2 months were considered.

RESULTS

There were differences regarding nasal respiratory mode, lips closed at rest posture, changed tongue tonus, adequate mobility of the soft palate, changed tongue posture during liquid swallowing, and absence of interposition compensatory mechanism of lips in swallowing. Reduction in the frequency of distortion processes was also found. With regard to speech, little improvement in vocal quality and resonance was seen.

CONCLUSION

Following adenotonsillectomy, some structures and functions can spontaneously readapt or improve. However, most children needed to be referred to speech therapy for readapting stomatognathic structures and the assessed functions.

Effects of septoplasty on speech and voice

OBJECTIVES

The aim of this study was subjective and objective evaluation of changes in acoustic features of voice before and after septoplasty surgery.

STUDY DESIGN

Prospective.

METHODS

Twenty patients scheduled for septoplasty procedure were included in the study. Before and 1 and 3 months after septoplasty surgery, acoustic analysis were performed. The recordings of /a/ vowel were used to evaluate average fundamental frequency (F0), Jitter percent, and Shimmer percent. In spectrographic analyses, F3-F4 values for the vowels /i, e, a, o, and u/, nasal formant frequencies of the consonants /m/ and /n/ in the word /mana/, and four formant frequencies (F1, F2, F3, and F4) for nasalized /a/ vowel following a nasal consonant /n/ in the word /mana/ were compared. For the perceptual evaluation, the patients were asked to read the Turkish "Dere" passage. The differences in nasal resonance and subjective evaluations were rated.

RESULTS

A statistically significant change was not observed in F0 (P=0.307), Jitter (P=0.919), and Shimmer (P=0.024) values measured before and after the operation for vowel /a/. Nasal formants measured before and after the operation for nasal formant /m/ and nasal formant /n/ in the word /mana/, which contains nasal consonants, and nasalized vowel /a/, which comes after a nasal consonant, did not differ statistically significant (P=0.096 and P=0.034, respectively). Comparisons among F1, F2, F3, and F4 values did not reveal a statistically significant change for nasalized vowel /a/, which comes after a nasal consonant in the word /mana/.

CONCLUSIONS

Our study shows that a complete therapeutic approach to patients affected by nasal septum deviation do not reveal significant voice abnormalities.

Hypertrophied tonsils impair velopharyngeal function after palatoplasty

OBJECTIVES/HYPOTHESIS

When tonsillar hypertrophy obstructing the airway is encountered in a child with a repaired cleft palate and velopharyngeal insufficiency, the surgeon may opt for tonsillectomy to relieve the airway obstruction, with possible effects on velopharyngeal closure. The aim of this study was to assess the impact of hypertrophied tonsils on velopharyngeal function in children with repaired cleft palate and to measure the effect of tonsillectomy on velopharyngeal closure and speech resonance.

STUDY DESIGN

Case series.

METHODS

Twelve children with repaired cleft palate and tonsillar hypertrophy underwent tonsillectomy to relieve airway obstruction. Preoperative and postoperative evaluation of velopharyngeal function was performed. Auditory perceptual assessment of speech and nasalance scores were measured, and velopharyngeal closure was evaluated by flexible nasopharyngoscopy.

RESULTS

Preoperative impairment of velopharyngeal function was detected. However, significant postoperative improvement of speech parameters (hypernasality, nasal emission of air, and weak pressure consonants measured with auditory perceptual assessment) was achieved, and the overall postoperative nasalance score was improved significantly for nasal and oral sentences. Reduction of velopharyngeal gap size was detected after removal of hypertrophied tonsils. Although the improvement of velopharyngeal closure was not significant, three cases demonstrated complete postoperative closure with no gap.

CONCLUSIONS

Hypertrophied tonsils may impair velopharyngeal function in children with repaired cleft palate, and tonsillectomy is beneficial for such patients as it can improve the velopharyngeal closure and speech resonance. Secondary corrective surgery may be avoided in some cases after tonsillectomy.

Thermal welding vs. cold knife tonsillectomy: a comparison of voice and speech

OBJECTIVE

To compare acoustic, aerodynamic and perceptual voice and speech parameters in thermal welding system tonsillectomy and cold knife tonsillectomy patients in order to determine the impact of operation technique on voice and speech.

METHODS

Thirty tonsillectomy patients (22 children, 8 adults) participated in this study. The preferred technique was cold knife tonsillectomy in 15 patients and thermal welding system tonsillectomy in the remaining 15 patients. One week before and 1 month after surgery the following parameters were estimated: average of fundamental frequency, Jitter, Shimmer, harmonic to noise ratio, formant frequency analyses of sustained vowels. Perceptual speech analysis and aerodynamic measurements (maximum phonation time and s/z ratio) were also conducted.

RESULTS

There was no significant difference in any of the parameters between cold knife tonsillectomy and thermal welding system tonsillectomy groups (p>0.05). When the groups were contrasted among themselves with regards to preoperative and postoperative rates, fundamental frequency was found to be significantly decreased after tonsillectomy in both of the groups (p<0.001). First formant for the vowel /a/ in the cold knife tonsillectomy group and for the vowel /i/ in the thermal welding system tonsillectomy group, second formant for the vowel /u/ in the thermal welding system tonsillectomy group and third formant for the vowel /u/ in the cold knife tonsillectomy group were found to be significantly decreased (p<0.05).

CONCLUSIONS

The surgical technique, whether it is cold knife or thermal welding system, does not appear to affect voice and speech in tonsillectomy patients.

Influence of adenotonsillar hypertrophy on /s/-articulation in children--effects of surgery

Tonsillar hypertrophy is common in young children and affects several aspects of the speech such as distortions of the dento-alveolar consonants. The study objective was to assess /s/-articulation, perceptually and acoustically, in children with tonsillar hypertrophy and compare effects of two types of surgery, total tonsillectomy and tonsillotomy. Sixty-seven children, aged 50-65 months, on the waiting list for surgery, were randomized to tonsillectomy or tonsillotomy. The speech material was collected preoperatively and 6 months postoperatively. Two groups of age-matched children were controls. /S/-articulation was affected acoustically with lower spectral peak locations and perceptually with less distinct /s/-production before surgery, in comparison to controls. After surgery /s/-articulation was normalized perceptually, but acoustic differences remained. No significant differences between surgical methods were found.

Effects of soft palate implants on acoustic characteristics of voice and articulation

OBJECTIVE

To evaluate the effects of soft palate implants on voice and articulation.

STUDY DESIGN

Prospective case series.

METHODS

Male subjects (n=23) diagnosed with mild obstructive sleep apnea and/or habitual snoring underwent acoustic analysis with the Multidimensional Voice Program (Kay Multi-Speech Model 3700 Advanced Version; Kay Elemetrics [KayPentax], Lincoln Park, NJ) before and 8 weeks after insertion of palatal implants to determine the effects of soft palate implants on voice and articulation. Sustained vowels (/a/e/u/o/i/) and phonetically balanced carrier sentences were used for acoustic analyses. Parameters measured were fundamental frequency (F0), jitter, shimmer, noise-to-harmonics ratio, Voice Turbulence Index, Soft Phonation Index, degree of voiceless, degree of voice breaks and peak amplitude variation, first formant (F1) and second formant (F2) frequencies, and voice onset time (VOT). F1 and F2 for each vowel were determined using linear predictive analysis on a spectrogram. VOT was measured for the palatal consonant /k/ and the dental consonant /t/ on a wideband spectrogram from a carrier sentence segment that contained a syllable with a stop consonant.

RESULTS

No statistically significant difference was detected in F0, F1, F2, or other MDVP parameters before and after implantation. Average VOT values measured for /t/ were not significantly different. On the other hand, average VOT values of /k/ were found to be significantly shorter.

CONCLUSIONS

Implant insertion had no significant effect on MDVP parameters, F0, F1, or F2. On the other hand, articulation as a function of velar region seemed to be affected because VOT values of velar /k/ were changed.

Phonological development in children with obstructive sleep-disordered breathing

Adeno-tonsillar hypertrophy with obstructive sleep disordered breathing (OSDB) is known to affect oral-motor function, behaviour, and academic performance. Adeno-tonsillectomy is the most frequently performed operation in children, with total tonsillectomy (TE) being more common than partial resection, 'tonsillotomy' (TT). In the present study 67 children, aged 50-65 months, with OSBD were randomized to TE or TT. The children's phonology was assessed pre-operatively and 6 months post-operatively. Two groups of children served as controls. Phonology was affected in 62.7% of OSBD children before surgery, compared to 34% in the control group (p < .001). Also, OSBD children had more severe phonological deficits than the controls (p < .001). Phonology improved 6 months equally after both surgeries. Despite improvement post-operatively, the gap to the controls increased. Other functional aspects, such as oral motor function, were normalized regardless of surgical method--TE or TT. The impact of OSBD should be considered as one contributing factor in phonological impairment.

Effects of uvulopalatopharyngoplasty with Harmonic Scalpel on speech and voice

The aim of this study was to evaluate changes in acoustic features of speech and voice after uvulopalatopharyngoplasty (UPPP) with the Harmonic Scalpel (HS), using the multidimensional voice program (MDVP) in conjunction with other tests. Before and 6 months after surgery, phonetically balanced sentences and sustained vowels a, e, i were carried out and digitalized with MDVP in all the patients, as an evaluation of nasal resonance (trough the Glatzel and the Gutzmann tests), speech articulation and voice handicap index (VHI). These parameters were estimated: average of fundamental frequency, Jitter, Shimmer, noise-to-harmonics ratio, voice turbulence index, soft phonation index, degree of voiceless, degree of voice breaks and peak amplitude variation. Six months after surgery, improvements in all the acoustic parameters, in nasalance and VHI were achieved. In our experiences UPPP, with the HS, improves speech and voice in patients affected by snoring and/or obstructive sleep apnea syndrome.

The impact of tonsillectomy with or without adenoidectomy on speech and voice

OBJECTIVES

The aim of this study was to evaluate changes in acoustic features of speech and voice after tonsillectomy with or without adenoidectomy.

METHODS

Before and 1 month after surgery the following parameters were estimated: average of fundamental frequency (Fo), Jitter percent (Jitt), Shimmer, noise-to-harmonics ratio (NHR), voice turbulence index (VTI), soft phonation index (SPI), degree of voiceless (DUV), degree of voice breaks (DVB) and peak amplitude variation (vAm); as an evaluation of nasal resonance, speech articulation and voice handicap index (VHI).

RESULTS

The results were statistically evaluated using the unpaired t-test. Probability values below 0.05 were regarded as significant. One month after surgery, our data showed significant (P<0.05) improvements of the acoustic and other parameters in the children submitted to adenotonsillectomy: Fo (176Hz vs. 206Hz, after sustained vowels: 206Hz vs. 192Hz; 148Hz vs. 168Hz; 171Hz vs. 161Hz after balanced sentences), Jitt (0.85% vs. 1.81% to 0.82% vs. 1.81%), Shimmer (3.41% vs. 5.81% to 4.89% vs. 5.73%), NHR (0.16 vs. 0.42 to 0.29 vs. 0.39), VTI (0.05 vs. 0.38 to 0.28 vs. 0.37), SPI (14.78 vs. 21.14-19.89 vs. 21.89), DUV (0% vs. 0.44% to 0% vs. 0.48%), DVB (0% vs. 0.42% to 0% vs. 0.42%) and vAm (8.93% vs. 23.89% to 8.89% vs. 24.25%).

CONCLUSIONS

The results suggest the role of adenotonsillectomy in the improvement of voice and speech quality and of objective evaluation of speech and voice in the correct management of these children.