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Karaoğullarından A, Okşan Erkan S. The Effects of Anterior Palatoplasty and Functional Expansion Sphincter Pharyngoplasty on Voice Quality in Patients with Obstructive Sleep Apnea. J Voice 2023:S0892-1997(22)00385-X. [PMID: 36641251 DOI: 10.1016/j.jvoice.2022.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES We aimed to examine the effects of anterior palatoplasty (AP) and functional expansion sphincter pharyngoplasty (FESP) on voice quality in patients with OSAS and to compare them with each other. MERHODS The study included 380 patients who came to the Otorhinolaryngology Clinic of our hospital with symptoms of snoring and sleep apnea between April 2020 and April 2022 and were referred to the sleep laboratory for polysomnography (PSG).Forty patients who met the study criteria and underwent AP and 26 patients who underwent FESP were included in the study. All surgeries were performed under general anesthesia by the same otolaryngologist within 1 month at the latest after sleep endoscopy. Acoustic voice analysis was performed using the Praat voice analysis program preoperatively and postoperatively at 6 months. F0, jitter, shimmer, and NHR (noise-to-harmonic ratio) were compared between the groups pre and postoperatively. RESULTS There were 20 females and 20 males in the AP group, 12 females and 14 males in the FESP group, There was no statistically significant difference in sex distribution between the groups (P = 0.952). The difference between the preop and postop F0, jitter, shimmer, and NHR in both the AP and FESP groups was statistically significant (P < 0.01). After AP and FESP surgeries, F0 values increased, jitter, shimmer and NHR values decreased (P < 0.01).F0, jitter, shimmer, and NHR changes were the greatest in the FESP group.(P < 0.01). CONCLUSION Positive changes in F0, jitter, shimmer, and NHR were greatest in the FESP group significantly. FESP surgery affects voice quality more than AP surgery in patients with OSAS.
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Affiliation(s)
- Ayşe Karaoğullarından
- ENT Specialist in Adana City Training and Research Hospital ENT Department, Yüreğir, Adana, Turkey.
| | - Sanem Okşan Erkan
- ENT Specialist in Adana City Training and Research Hospital ENT Department, Yüreğir, Adana, Turkey
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Yaslıkaya S, Geçkil AA, Birişik Z. Is There a Relationship between Voice Quality and Obstructive Sleep Apnea Severity and Cumulative Percentage of Time Spent at Saturations below Ninety Percent: Voice Analysis in Obstructive Sleep Apnea Patients. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58101336. [PMID: 36295497 PMCID: PMC9608866 DOI: 10.3390/medicina58101336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/19/2022]
Abstract
Background and Objectives: Apnea hypopnea index is the most important criterion in determining the severity of obstructive sleep apnea (OSA), while the percentage of the total number of times which oxygen saturation is measured below 90% during polysomnography (CT90%) is important in determining the severity of hypoxemia. As hypoxemia increases, inflammation will also increase in OSA. Inflammation in the respiratory tract may affect phonation. We aimed to determine the effects of the degree of OSA and CT90% on phonation. Materials and Methods: The patients were between the ages of 18−60 years and were divided into four groups: normal, mild, moderate, and severe OSA. Patients were asked to say the vowels /α:/ and /i:/ for 5 s for voice recording. Maximum phonation time (MPT) was recorded. Using the Praat voice analysis program, Jitter%, Shimmer%, harmonics-to-noise ratio (HNR), and f0 values were obtained. Results: Seventy-two patients were included. Vowel sound /α:/; there was a significant difference for Jitter%, Shimmer%, and HNR measurements between the 1st and the 4th group (p < 0.001, p < 0.001, and p < 0.001, respectively) and a correlation between CT90% and Shimmer% and HNR values (p < 0.001 and p < 0.021, respectively). Vowel sound /i:/; there was a significant difference in f0 values between the 1st group and 2nd and 4th groups (p < 0.028 and p < 0.015, respectively), and for Jitter%, Shimmer%, and HNR measurements between the 1st and 4th group (p < 0.04, p < 0.000, and p < 0.000, respectively), and a correlation between CT90% and Shimmer% and HNR values (p < 0.016 and p < 0.003, respectively). The difference was significant in MPT between the 1st group and 3rd and 4th groups (p < 0.03 and p < 0.003, respectively). Conclusions: Glottic phonation can be affected, especially in patients whose AHI scores are ≥15. Voice quality can decrease as the degree of OSA increases. The increase in CT90% can be associated with the worsening of voice and can be used as a predictor in the evaluation of voice disorders in the future.
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Affiliation(s)
- Serhat Yaslıkaya
- Department of Otorhinolaryngology, Faculty of Medicine, Adıyaman University, Adıyaman 02100, Turkey
- Correspondence: ; Tel.: +90-4162161015
| | - Ayşegül Altıntop Geçkil
- Department of Chest Diseases, Faculty of Medicine, Malatya Turgut Özal University, Malatya 44210, Turkey
| | - Zehra Birişik
- Department of Speech and Language Therapy, Malatya Training and Research Hospital, Malatya 44000, Turkey
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Gashimli RM, Mamedov VZ, Huseynov NM. [Subjective assessment of the effect of septoplasty on respiratory and voice functions]. Vestn Otorinolaringol 2022; 87:4-6. [PMID: 35818938 DOI: 10.17116/otorino2022870314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To assess the impact of septoplasty on quality of life by measuring changes in nasal breathing and voice function using subjective assessment questionnaires. MATERIAL AND METHODS The study included 98 patients who underwent septoplasty for the nasal septum deviation. The effect of the operation on nasal breathing was assessed subjectively using the Nasal Obstruction Septoplasty Effectiveness (NOSE) questionnaire, and the effect on voice function was assessed using the Voice Handicap Index-30 (VHI-30) questionnaire. RESULTS There was a statistically significant difference between the preoperative and postoperative (after 1 and 3 months) NOSE data (in both cases, p<0.001) and and between the indicators 1 and 3 months after surgery (p<0.001). There was a statistically significant difference (p<0.001 in both cases) between the preoperative VHI-30 and 1 and 3 months postoperatively. There was also a statistically significant difference (p<0.001) between 1 and 3 months after surgery for this test. CONCLUSION In this study, the effect of septoplasty on respiratory and voice function was demonstrated using subjective tests. In the postoperative period, patients subjectively positively assessed changes in both nasal breathing and voice.
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Affiliation(s)
- R M Gashimli
- Aliyev Azerbaijan State Institute of Advanced Medical Training, Baku, Azerbaijan
| | - V Z Mamedov
- Aliyev Azerbaijan State Institute of Advanced Medical Training, Baku, Azerbaijan
| | - N M Huseynov
- Aliyev Azerbaijan State Institute of Advanced Medical Training, Baku, Azerbaijan
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Karakurt SE, Karakuş MF, Eravcı FC, Kum N, Özcan M, Özcan KM. Evaluation of the Relationship Between the Required Pressure Level in Continuous Positive Airway Pressure Treatment and Voice in Patients With Obstructive Sleep Apnea Syndrome. J Voice 2021; 35:609-613. [DOI: 10.1016/j.jvoice.2019.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/05/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
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Voice outcomes for patients undergoing surgery for obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2020; 277:3261-3281. [PMID: 32488379 DOI: 10.1007/s00405-020-06101-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/29/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of the different surgical techniques used in the treatment of obstructive sleep apnea (OSA) on the postoperative voice and nasalance, and to conduct a meta-analysis through the assessment of postoperative changes. METHODS Systematic literature review and meta-analysis of published data using the data sources, MEDLINE, Google Scholar, Cochrane, and SAGE. All studies published in English specifying any upper airway surgery for treatment of snoring and/or OSA were included, provided they indicated the pre- and postoperative mean ± standard deviation (SD) values for voice parameters and nasality. The primary outcomes were the changes in preoperative-postoperative mean values of fundamental frequency (mF0), jitter, shimmer, and nasalance scores. RESULTS After removal of duplications, 214 studies were potentially relevant, and 25 studies ultimately met the criteria for inclusion in the present review. Of the 25 studies evaluated in this review, 12 studies with 379 patients were available for the meta-analysis calculations. In general, a fixed-effects model was used to analyze the data in the subgroups. The meta-analysis results showed no significant differences in either subgroup analysis between the preoperative and postoperative assessments of mF0, jitter, shimmer, oral nasalance, nasal nasalance, and oronasal nasalance (All had values of p > 0.05). CONCLUSION The results of this meta-analysis indicated no significant effect of surgical treatments for snoring or OSA on glottic functioning and nasalance parameters, regardless of surgery type. Further prospective studies are needed to assess more parameters for detailed acoustic analyses.
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Guyton KB, Sandage MJ, Bailey D, Haak N, Molt L, Plumb A. Acquired Velopharyngeal Dysfunction: Survey, Literature Review, and Clinical Recommendations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1572-1597. [PMID: 30208483 DOI: 10.1044/2018_ajslp-17-0222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/10/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this study was to describe the clinical assessment recommendations for acquired velopharyngeal dysfunction (AVPD) and, through a literature review and online survey, summarize current practice patterns for evaluation and treatment pathway determination for this target population. METHOD An online survey to query current assessment procedures and treatment pathway recommendations for AVPD was developed. Following survey results, a literature review was completed to determine evidence-based recommendations for assessment procedures and intervention recommendations based on assessment findings. Literature search terms included the following: acquired velopharyngeal dysfunction, hypernasality, non-cleft velopharyngeal dysfunction, velopharyngeal dysfunction, velopharyngeal dysfunction AND iatrogenic, velopharyngeal dysfunction AND neurogenic, velopharyngeal dysfunction AND assessment OR evaluation, velopharyngeal dysfunction AND treatment OR intervention, velopharyngeal dysfunction AND practice patterns OR clinical guidelines, velopharyngeal insufficiency. Inclusion criteria were limited to practice patterns/recommendations for assessment and/or treatment recommendations for AVPD, English language articles published between 2000 and 2017, and peer-reviewed journals. Studies regarding solely congenital or cleft palate velopharyngeal dysfunction and intervention outcome studies were excluded. Forty articles met inclusionary criteria. RESULTS The online survey results indicated lack of consensus for AVPD assessment and treatment recommendation protocols, with 93% of respondents indicating the need for a clinical guide for developing treatment recommendations. The majority of recommendations were filtered into an algorithm for clinical decision making. CONCLUSIONS Clinical uncertainty among speech-language pathologists surveyed and the paucity of published clinical guidelines for assessing individuals with AVPD indicate the need for additional clinical research for this disorder, one that is heterogeneous and distinct from those with congenital velopharyngeal dysfunction. The proposed evidence-based clinical worksheet may assist in determining management for patients with AVPD and may serve as a starting place for validation of a clinical guideline.
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Affiliation(s)
- Kelsey B Guyton
- Department of Communication Disorders, Auburn University, AL
| | - Mary J Sandage
- Department of Communication Disorders, Auburn University, AL
| | - Dallin Bailey
- Department of Communication Disorders, Auburn University, AL
| | - Nancy Haak
- Department of Communication Disorders, Auburn University, AL
| | - Lawrence Molt
- Department of Communication Disorders, Auburn University, AL
| | - Allison Plumb
- Department of Communication Disorders, Auburn University, AL
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Ziade G, Kasti M, Sarieddine D, Saadeddine Z, Hamdan AL. Clinical application of nasometry in patients with nasal obstruction. EAR, NOSE & THROAT JOURNAL 2018; 96:E13-E16. [PMID: 29121380 DOI: 10.1177/0145561317096010-1104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Georges Ziade
- Department of Otolaryngology, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon
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Stuck BA, Ravesloot MJL, Eschenhagen T, de Vet HCW, Sommer JU. Uvulopalatopharyngoplasty with or without tonsillectomy in the treatment of adult obstructive sleep apnea - A systematic review. Sleep Med 2018; 50:152-165. [PMID: 30056286 DOI: 10.1016/j.sleep.2018.05.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/23/2017] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND The most commonly performed surgical procedure for obstructive sleep apnea (OSA) is uvulopalatopharyngoplasty with or without tonsillectomy (UPPP ± TE). However, there is currently no review solely focusing on clinically relevant effects of standard UPPP technique with or without tonsillectomy as a monotherapy in patients with OSA. METHODS A systematic review and meta-analysis were performed to assess the effects of isolated UPPP ± TE in patients with OSA. Studies of any design referring to adult patients with obstructive sleep apnea diagnosed via polysomnography or comparable objective measures were considered, in which isolated "standard" UPPP ± TE was performed. RESULTS Forty-eight studies were included for the qualitative analysis. All but one study demonstrated a reduction in the frequency of respiratory events and success/response rates ranged from 35 to 95.2%. In the six studies that reported pre- and postoperative mean scores of the Epworth Sleepiness Scale (ESS), a reduction in sleepiness scores was demonstrated. Data addressing the effect of UPPP ± TE in comparison to no treatment or control were available from two randomized controlled trials (RCT). When pooling the data, UPPP ± TE was significantly more effective in reducing the apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) (large effect): an AHI mean difference (MD) of -18.59 (95% CI -34.14, -3.04) and an ESS MD of -5.37 (95% CI -7,03, -3.72). Data addressing effect of UPPP ± TE in comparison to baseline was available from three RCT. When pooling the data, the AHI was reduced from a mean 35.4 to 17.9 (49.5% reduction); a MD of -20.41, 95% CI -32.78, -8.04 (-1.80, -1.15) (large effect). Various additional beneficial effects of UPPP ± TE were demonstrated including improvement in sexual function, ventricular function, sleep stages, serum lipid, depressive disorder and driving performance. CONCLUSION UPPP ± TE reduces respiratory events and daytime sleepiness in adult patients with OSA and UPPP ± TE is superior to non-treated controls in this regard. Further research is needed to establish the long-term benefit, the impact on cardiovascular morbidity and the role of UPPP ± TE in the variety of available treatment options for OSA.
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Affiliation(s)
- Boris A Stuck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Marburg, Philipps-Universität Marburg, Germany
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Amsterdam, The Netherlands.
| | - Till Eschenhagen
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - H C W de Vet
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - J Ulrich Sommer
- Department of Otorhinolaryngology Head and Neck Surgery, Medical Faculty Mannheim, University of Heidelberg, Germany
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The Effect of Anterior Palatoplasty Plus Modified Expansion Sphincter Pharyngoplasty on Voice Performance in Obstructive Sleep Apnea Syndrome. J Craniofac Surg 2018; 28:e464-e467. [PMID: 28665845 DOI: 10.1097/scs.0000000000003762] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE We aimed to investigate the effect of anterior palatoplasty (AP) plus modified expansion sphincter pharyngoplasty (MESP) on voice performance in patients with obstructive sleep apnea syndrome (OSAS). METHODS Fourteen OSAS patients who had AP + MESP procedure were included in the study. Voice performances of the patients were analyzed with acoustic voice analysis before surgery, and 6 months after surgery. RESULTS Preoperative and postoperative F0, jitter percentage, and shimmer percentage were compared. Mean preoperative F0 was 129.85 Hz, and mean postoperative F0 was 138.07 Hz, with a significant difference in between (P = 0.017). Mean preoperative jitter percentage was 0.65, and mean shimmer percentage was 0.88, while those values were 0.67 and 0.84, respectively, in the postoperative period. The differences were not statistically significant (P = 0.801 and 0.652). CONCLUSION The AP + MESP procedure performed for OSAS results in improvement of F0 in the long term; however, there were no differences in jitter percentage and shimmer percentage.
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Park SK, Lee YS, Kang YA, Xu J, Rha KS, Kim YM. The effects of uvulopalatal flap operation on speech nasalance and the acoustic parameters of the final nasal consonants. Auris Nasus Larynx 2017; 45:311-319. [PMID: 28712601 DOI: 10.1016/j.anl.2017.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/10/2017] [Accepted: 06/07/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The acoustic characteristics of voice are determined by the source of the sound and shape of the vocal tract. Various anatomical changes after uvulopalatal flap (UPF) operation can change nasalance and/or other voice characteristics. Our aim was to explore the possible effects of UPF creation on speech nasalance and the resonatory features of the final nasal consonants, and thus voice characteristics. METHODS A total of 30 patients (26 males, 4 females) with obstructive sleep apnea who underwent UPF operation were recruited. A Nasometer II 3.4 instrument was used to assess nasalance pre- and post-operatively; the patients read standard Korean passages and the readings were recorded in Computer Speech Laboratory for later spectral analysis. Praat software was used to identify frequency bands affecting perioperative nasalance scores. Minima, maxima, and slopes were analyzed. RESULTS We found no significant correlation between nasalance scores (any passage) and the respiratory distress index or body mass index. No significant perioperative change in any nasalance score. The moment variations in the final consonants /m/ and /n/ did not change significantly postoperatively. However, the postoperative moment variation of the final consonant /ng/ differed significantly in the third formant (F3) and second bandwidth (BW2). CONCLUSION Few significant changes in nasal resonance speech quality were apparent after UPF operation. However, a postoperative acoustic change in the final sound /ng/ may be sustained. Patients may be preoperatively advised that the risk of voice change is very low, but not absent.
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Affiliation(s)
- Soo Kyoung Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yong Soo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Young Ae Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Jun Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Yanbian University Hospital, Yanji, China
| | - Ki Sang Rha
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea
| | - Yong Min Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute for Medical Science, Chungnam National University School of Medicine, Daejeon, Republic of Korea.
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Yang CC, Wang YP, Chang CW. Changes in the nasalance of vowels within the first week following uvulopalatopharyngoplasty. EAR, NOSE & THROAT JOURNAL 2017; 95:E43-6. [PMID: 26930343 DOI: 10.1177/014556131609500211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We conducted a retrospective study to evaluate the short-term effect of uvulopalatopharyngoplasty (UPPP) on changes in the nasalance of five vowels: /a/, /ε/, /i/, /ɔ/, and /u/. Our study group was made up of 20 patients-15 males and 5 females, aged 16 to 57 years (mean: 37.3 ± 11.5)-who had undergone UPPP as a treatment for mild to moderate obstructive sleep apnea. Nasometry was used to obtain nasalance scores in all patients on the morning of the operation (day 1) and subsequently on day 4 or 5 (mean: 4.5 ± 0.5). Preoperatively, nasalance scores were highest for /i/ (mean: 29.8 ± 12.6) and /a/ (mean: 24.1 ± 10.3). After the operation, nasalance scores for all five studied vowels increased; they were highest for /i/ (mean: 40.7 ± +17.8) and /ε/ (mean: 30.0 ± 10.8). The increases in the nasalance of /i/, /ε/, and /u/ were statistically significant (p < 0.05). Our findings indicate that UPPP has a significant impact on nasalance immediately after surgery.
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Affiliation(s)
- Cheng-Chien Yang
- Corresponding author: Ying-Piao Wang, MD, PhD, Department of Audiology and Speech Language Pathology and School of Medicine, Mackay Medical College, New Taipei City, Taiwan. From the Department of Otolaryngology, Hearing and Speech Center, Mackay Memorial Hospital, Taipei, Taiwan (Dr. Yang, Dr. Wang, and Ms. Chang); and the Department of Audiology and Speech Language Pathology and the School of Medicine, Mackay Medical College, New Taipei City, Taiwan. (Dr. Yang and Dr. Wang). The study described in this article was conducted at Mackay Memorial Hospital
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Arslan F, Polat B, Durmaz A, Birkent H. Effects of Nasal Obstruction due to Nasal Polyposis on Nasal Resonance and Voice Perception. Folia Phoniatr Logop 2016; 68:141-143. [DOI: 10.1159/000452490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Do Pharyngeal Surgeries for Snoring and Obstructive Sleep Apnea Have an Impact on Nasalance Scores? J Craniofac Surg 2016; 26:2213-6. [PMID: 26413964 DOI: 10.1097/scs.0000000000002101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Most of the surgeries which are used in the treatment of habitual snoring and obstructive sleep apnea (OSA) mainly target velopharyngeal structures, which play an important role in voice characteristics such as nasalance. The aim of this study is to assess the effect of different types of such surgical procedures including expansion sphincter pharyngoplasty (ESP), lateral pharyngoplasty (LP), and anterior palatoplasty (AP) on nasalance scores. SUBJECTS AND METHODS Forty-nine consecutive patients with primary snoring or OSA who underwent AP, LP, and ESP procedures were included in this study. All patients underwent a fully attended overnight polysomnography and detailed otolaryngologic examination. Nasalance studies were performed with Nasometer II instrument (model 6400; Kay Elemetrics, Lincoln Park, NJ) by reading 3 passages that were categorized according to the amount of nasal consonants (oral, oro-nasal, and nasal passages), preoperatively, and 3 months after surgery. RESULTS There was no statistically significant difference in either group between preoperative and postoperative assessments of nasalance scores for all 3 passages. Seven patients experienced nasal regurgitation symptoms for fluids for a short time after LP, 2 patients after AP, and 7 patients after ESP. None of these symptoms showed persistence and diminished approximately at 1-month follow-up. CONCLUSION Anterior palatoplasty, LP, and ESP seem not to have any impact on nasalance scores of males.
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Gulec S, Kulahli I, Sahin MI, Kokoğlu K, Gunes MS, Avci D, Arli T. Effect of Septoplasty on Voice Quality: A Prospective-Controlled Trial. Clin Exp Otorhinolaryngol 2016; 9:238-43. [PMID: 27230274 PMCID: PMC4996097 DOI: 10.21053/ceo.2015.01354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/17/2015] [Accepted: 11/17/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives. The purpose is to investigate effect of septoplasty and widened nasal patency on voice quality. Methods. Fifty patients who undergone septoplasty were included in the study. Thirty-three people who had similar age and distribution were enrolled as control group. Before and 1 and 3 months after surgery, anterior rhinomanometry, voice analysis by Multi-Dimensional Voice Program, and spectrographic analysis were performed to patients. 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 /mini/, and 4 formant frequencies (F1, F2, F3, and F4) for nasalized /i/ vowel following a nasal consonant /n/ in the word /mini/ were compared. The differences in nasal resonance were evaluated. All patients were asked whether change in their voices after the surgery. Preoperative and postoperative voice parameters and anterior rhinomanometry results were compared separately with the control group as well as in the patient group itself. Results. Preoperative total nasal resistance (TNR) values of patients were higher than the control group (P=0.001). TNR values of patients measured one day before surgery and after surgery in the 1st and 3rd months were different and these differences were significant statistically (P=0.001). There was no significant difference between the voice analysis parameters in preoperative, postoperative 1st, and 3rd months. As a result of their subjective reviews, 12 patients (36%) noted their voices were better than before surgery and 20 patients (61%) noted no change before and after surgery. Conclusion. Providing widened nasal cavity has no effect on voice quality.
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Affiliation(s)
- Safak Gulec
- Department of Otolaryngology, Private Neon Hospital, Erzincan, Turkey
| | - Ismail Kulahli
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Ilhan Sahin
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Kerem Kokoğlu
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Salih Gunes
- Department of Otolaryngology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Deniz Avci
- Department of Otolaryngology, Patnos State Hospital, Agri, Turkey
| | - Turan Arli
- Deprtment of Otolaryngology, Kasımpasa Military Hospital, Istanbul, Turkey
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Göker AE, Aydoğdu İ, Saltürk Z, Berkiten G, Atar Y, Kumral TL, Uyar Y. Comparison of Voice Quality Between Patients Who Underwent Inferior Turbinoplasty or Radiofrequency Cauterization. J Voice 2016; 31:121.e17-121.e21. [PMID: 27068423 DOI: 10.1016/j.jvoice.2016.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to analyze and compare the vocal quality in patients who underwent either submucosal turbinectomy or radiofrequency cauterization. METHODS In this study, we enrolled 60 patients diagnosed with inferior concha hypertrophy. These patients were divided into two groups by using computer program "Research Randomizer." Of the 60 patients, 30 underwent submucosal inferior turbinoplasty and 30 underwent radiofrequency cauterization. The control group was composed of 30 healthy adults with no nasal or upper aerodigestive system pathology. The patients were checked at weeks 1, 2, and 4. Voice records were taken before the procedure and at week 4 postprocedure. RESULTS The mean age of patients in the inferior turbinoplasty group was 29.4 years (range: 19-42 years); in the radiofrequency group, it was 30.30 years (range: 18-50 years). There was no statistical difference in age between groups. In the inferior turbinoplasty group, there were 16 male and 14 female patients, and in the radiofrequency group, there were 13 male and 17 female patients. There was no significant difference in the number of males and females between groups. CONCLUSIONS Voice professionals, especially singers, actors, and actresses, should be informed about possible voice changes before undergoing endonasal surgery because these individuals are more sensitive to changes in resonance organs. We believe that voice quality should be regarded as a highly important parameter when measuring the success of endonasal surgery.
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Affiliation(s)
| | - İmran Aydoğdu
- ENT Department, Bahçelievler Government Hospital, Ankara, Turkey
| | - Ziya Saltürk
- Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Güler Berkiten
- Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Okmeydanı Training and Research Hospital, Istanbul, Turkey
| | | | - Yavuz Uyar
- Okmeydanı Training and Research Hospital, Istanbul, Turkey
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Atan D, Köseoğlu S, Özcan KM, İkincioğulları A, Topak AB, Özcan İ, Dere H. Evaluation of Liver Functions Based on Serum Aminotransferase Enzyme Levels in Patients with Obstructive Sleep Apnea Syndrome. Indian J Otolaryngol Head Neck Surg 2015; 71:1679-1682. [PMID: 31763223 DOI: 10.1007/s12070-015-0914-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is associated with fatty liver disease. In the present study, relations between alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels and the severity of OSAS and polysomnography parameters were investigated. The study included 194 patients with OSAS and 114 control patients. The patients underwent an overnight polysomnography (PSG) in the Sleep Laboratory. ALT and AST levels were compared between the patients and the controls and between the subgroups of the patients. ALT and AST levels were also compared with the PSG parameters REM AHI, NREM AHI and minimum O2 saturation separately. The mean ALT was 28.95 in the patients and 17.85 in the controls (p < 0.001) with a statistically significant difference and the mean AST was 23.62 in the patients and 16.53 in the controls with a statistically significant difference (p < 0.001). The patients with OSAS had significantly higher ALT and AST levels. The higher the ALT and AST levels were, the more severe the disease was, though the differences between the subgroups of the patients were not significant.
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Affiliation(s)
- Doğan Atan
- 1Ankara Numune Education and Research Hospital, Samanpazarı, Ankara, Turkey
| | | | - Kürşat Murat Özcan
- 1Ankara Numune Education and Research Hospital, Samanpazarı, Ankara, Turkey
| | | | - Ayşe Betül Topak
- 1Ankara Numune Education and Research Hospital, Samanpazarı, Ankara, Turkey
| | - İbrahim Özcan
- 3Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Hüseyin Dere
- 1Ankara Numune Education and Research Hospital, Samanpazarı, Ankara, Turkey
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17
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The effect of obstructive sleep apnea syndrome and continuous positive airway pressure treatment on voice performance. Sleep Breath 2014; 19:777-82. [DOI: 10.1007/s11325-014-1092-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 09/28/2014] [Accepted: 10/21/2014] [Indexed: 11/27/2022]
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Nasalance scores in pediatric patients after adenoidectomy. Int J Pediatr Otorhinolaryngol 2014; 78:610-3. [PMID: 24507662 DOI: 10.1016/j.ijporl.2014.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/06/2014] [Accepted: 01/08/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adenoidectomy is one of the most frequently performed operations in childhood. Nasal obstruction and chronic infection are the basic indications for surgery. Nasometer measures both oral and nasal air pressure during loud speech, and calculates their ratio. The aim of this study was to compare the mean nasal values in patients who had adenoidectomy at different ages against a control group. METHODS Eighty children between the ages of three and sixteen that had adenoidectomy in our clinic between 2006 and 2010 were compared against eighty age-matched controls who had not had nasal obstruction in their lifetime and were proven to have open nasal airways on physical examination. RESULTS Statistical analysis of the data showed that mean nasalance scores were significantly lower in patients who had adenoidectomy before 6 years of age when compared to the ones who had the operation after the age of six. In addition, when we compared the children who had adenoidectomy before 5 years of age and between 5 and 6 years of age, we found that their nasalance scores were significantly lower when compared to those who had adenoidectomy after the age of six (p = 0.017 and p = 0.019, respectively). CONCLUSION This study has shown that, even when adenoidectomy is performed, hyponasality may continue in clinically symptomatic patients under the age of six, and that there are no determined risk factors other than the early age.
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Foroughian M, Khazaeni K, Haghi MR, Jahangiri N, Mashhadi L, Bakhshaee M. The potential effects of rhinoplasty on voice. Plast Reconstr Surg 2014; 133:109e-113e. [PMID: 24469181 DOI: 10.1097/01.prs.0000436851.24903.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rhinoplasty is one of the most popular cosmetic surgical procedures in Iran. Surgery on the vocal tract can potentially change the voice characteristics. To the best of the authors' knowledge, no study has described voice changes after rhinoplasty, and the results of this study may help physicians to be aware of potential voice alterations following rhinoplasty. METHODS The authors selected 27 patients for this study. Patients completed Voice Handicap Index questionnaires, and the authors performed perceptual and acoustic analyses before and 5 months after rhinoplasty. RESULTS The Voice Handicap Index score and its physical and emotional subscales showed a statistically significant increase after rhinoplasty, indicating a worsening of voice quality after rhinoplasty. Blind perceptual analysis by six trained listeners revealed a statistically significant increase in hyponasality after rhinoplasty. Acoustic analysis showed that the frequency of the first and second nasal murmurs increased for the phonemes "m" and "n," while the amplitude of these murmurs decreased significantly after surgery. The same pattern was seen for the phoneme "a" when it was produced between two nasal consonants, as in the word "man." CONCLUSIONS Rhinoplasty can change vocal characteristics by narrowing the nasal cavity. Rhinoplasty has some effects on the voice, but these changes are problematic in general for most patients. However, for individuals who rely on their voice for professional reasons, the surgeon should preoperatively discuss these changes with the patient and consider more conservative types of surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Mahdi Foroughian
- Mashhad, Iran From the Sinus and Surgical Endoscopic Research Center, and the Students Research Committee, School of Medicine, Mashhad University of Medical Sciences; and the Department of Linguistics, Faculty of Letters and Humanities, Ferdowsi University of Mashhad
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Abu El-ella MY, Eldin HE, Malki KH, Samir MM, Abd Al-Naser NH, Mohamed AA. Effect of classic uvulopalatopharyngoplasty and laser-assisted uvulopalatopharyngoplasty on voice acoustics and speech nasalance. Ann Saudi Med 2010; 30:459-63. [PMID: 21060158 PMCID: PMC2994162 DOI: 10.4103/0256-4947.72266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Uvulopalatopharyngoplasty (UPPP) is a commonly used surgical technique for oropharyngeal reconstruction in patients with obstructive sleep apnea (OSA). This procedure can be done either through the classic or the laser-assisted uvulopalatopharyngoplasty (LAUP) technique. The purpose of this study was to evaluate the effect of classic UPPP and LAUP on acoustics of voice and speech nasalance, and to compare the effect of each operation on these two domains. PATIENTS AND METHODS The study included 27 patients with a mean age of 46 years. All patients were diagnosed with OSA based on polysomnographic examination. Patients were divided into two groups according to the type of surgical procedure. Fifteen patients underwent classic UPPP, whereas 12 patients were subjected to LAUP. A full assessment was done for all patients preoperatively and postoperatively, including auditory perceptual assessment (APA) of voice and speech, objective assessment using acoustic voice analysis and nasometry. RESULTS Auditory perceptual assessment of speech and voice, acoustic analysis of voice and nasometric analysis of speech did not show statistically significant differences between the preoperative and postoperative evaluations in either group (P>.05). CONCLUSION The results of this study demonstrated that in patients with OSA, the surgical technique, whether classic UPPP or LAUP, does not have significant effects on the patients' voice quality or their speech outcomes.
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Akpinar ME, Kocak I, Gurpinar B, Esen HE. Effects of soft palate implants on acoustic characteristics of voice and articulation. J Voice 2010; 25:381-6. [PMID: 20434875 DOI: 10.1016/j.jvoice.2010.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 01/12/2010] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Meltem Esen Akpinar
- Department of Otorhinolaryngology-Head and Neck Surgery, Istanbul Surgery Hospital, KBB Major, Istanbul, Turkey.
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