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Charters E, Pelham C, Novakovic D, Madill C, Clark J. Velopharyngeal incompetence following transoral robotic surgery for oropharyngeal carcinoma: A scoping review. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:540-548. [PMID: 35975948 DOI: 10.1080/17549507.2022.2104927] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Following transoral robotic surgery (TORS) for oropharyngeal carcinoma (OPC), velopharyngeal incompetence (VPI) is a known consequence that may contribute to swallowing and speech disorders. As the incidence of OPC increases affecting a younger demographic, a better understanding of VPI is required to support speech and swallowing rehabilitation. METHOD A scoping review was conducted using Arskey & O'Malley's framework. Studies were identified from five databases between 2007 and 2020. The methodological quality was measured with the RevMan Risk of Bias Tool by two independent evaluators. RESULT A total of seven studies met the inclusion criterion. There was a combined total of 306 participants, their average age was 59.2 years. A high risk of bias and degree of heterogeneity across all seven cohort studies was observed. Validated and instrumental evaluations of VPI were present in two papers, with the majority only reporting the presence or absence of VPI. The incidence of VPI reported in each study ranged from 0 to 53%, (median 3.5%). CONCLUSION There are few high-quality studies and considerable heterogeneity in the terminology, inclusion criteria and measurement of VPI. Instrumentation, to date, has been rarely used but is necessary for a normed and validated approach to VPI. Based on this review, there is considerable need for larger studies which instrumentally and longitudinally assess VPI as a consequence of TORS, in order to guide patient education and management prior to, and following their surgery.
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Affiliation(s)
- Emma Charters
- Department of Speech Pathology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Claire Pelham
- Department of Speech Pathology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Daniel Novakovic
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia
| | - Cate Madill
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jonathan Clark
- Sydney Medical School, Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, Australia
- Sydney Head and Neck Cancer Institute, Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia
- Royal Prince Alfred Institute of Academic Surgery, Sydney Local Health District, Sydney, Australia
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Pan YA, Wang YP, Lee GS, Hsieh LC, Chen YC. Increased nasality of connected speech in patients underwent modified Lothrop procedure for refractory chronic rhinosinusitis: Cross-sectional and prospective study. J Chin Med Assoc 2022; 85:1154-1159. [PMID: 36000964 DOI: 10.1097/jcma.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The endoscopic modified Lothrop procedure (EMLP) is performed to create a large frontal neostium in patients who had failed previous frontal sinus surgeries. EMLP causes obvious changes in the volume and anatomy of the sinuses, which may cause a more significant change in nasality. This study aimed to evaluate the changes in nasalance in patients who underwent EMLP by comparing their preoperative nasalance to the established normative values and postoperative nasalance. METHODS This was a prospective study. Twenty-one patients diagnosed with refractory frontal sinusitis who were indicated to undergo EMLP were enrolled. One hundred one healthy participants were enrolled as norm references. The Nasometer II Model 6400 (KayPENTAX) was used to analyze the nasalance scores. Nasalance scores were tested before surgery and 1 and 3 months after the surgery. RESULTS The normative references of nasalance were (mean ± SD) 14.6% ± 6.7%, 39.4% ± 8.4%, and 55.8% ± 8.3% for the oral passage, oral-nasal passage, and nasal sentences, respectively. The mean nasalance scores pre-EMLP and 1 and 3 months post-EMLP were 23.2% ± 9.6%, 29.0% ± 9.3%, and 29.9% ± 0.4% for the oral passage; 48.7% ± 10.7%, 54.7% ± 7.7%, and 56.4% ± 7.2% for the oral-nasal passage; and 62.7% ± 10.9%, 69.8% ± 6.7%, and 70.7% ± 6.4% for the nasal sentences, respectively. Compared with the normative references, pre-EMLP nasalance was higher for all the three speech stimuli (t-test, p < 0.05). Post-EMLP nasalance also significantly increased for all the three stimuli at the 1- and 3-month follow-up visits (Paired t-test, p < 0.05). CONCLUSION EMLP has a short-term impact on resonance; however, long-term follow-up is required for further study.
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Affiliation(s)
- Yi-An Pan
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
| | - Ying-Piao Wang
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Guo-She Lee
- School of Medicine, College of Medicine, Yangming Campus, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan, ROC
| | - Li-Chun Hsieh
- Department of Otolaryngology Head and Neck Surgery, Mackay Memorial Hospital, Taipei, Taiwan, ROC
- School of Medicine, Mackay Medical College, New Taipei City, Taiwan, ROC
- Department of Audiology and Speech Language Pathology, Mackay Medical College, New Taipei City, Taiwan, ROC
| | - Yi-Chen Chen
- Department of Special Science, University of Taipei, Taipei, Taiwan, ROC
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Johnson KB, Stoddard D, Cruz M, Michels KS. Changes in perception of pitch during vocal performance after three- and two-wall orbital decompression surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221088722. [PMID: 35416077 DOI: 10.1177/01455613221088722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This case series presents 2 Caucasian females that underwent orbital decompression surgery for symptomatic exophthalmos and postoperatively developed a change in their perception of pitch during vocal performance. One patient went as far as to undergo voice lessons in attempt to regain her pre-operative pitch perception; however, the attempt was unsuccessful. We propose the etiology of this complication is anatomic changes within the ethmoid sinus. Temporary changes in nasalance have previously been reported with functional endoscopic sinus surgery literature, but this specific complication of change in pitch perception has not.
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Affiliation(s)
- Kasey B Johnson
- 445950Washington State University Elson S Floyd College of Medicine, Spokane, WA, USA
| | - David Stoddard
- 445950Washington State University Elson S Floyd College of Medicine, Spokane, WA, USA
| | - Michael Cruz
- 445950Washington State University Elson S Floyd College of Medicine, Spokane, WA, USA
| | - Kevin S Michels
- 445950Washington State University Elson S Floyd College of Medicine, Spokane, WA, USA
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Yang KL, Luo SD, Tsai MH, Chang Y, Kuo HY, Chen WC. Nasality outcome in unilateral chronic rhinosinusitis following functional endoscopic sinus surgery. J Formos Med Assoc 2021; 121:936-942. [PMID: 34281727 DOI: 10.1016/j.jfma.2021.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND/PURPOSE In this study we aimed to investigate the prevalence of abnormal nasality in patients with unilateral rhinosinusitis and their nasality outcomes following functional endoscopic sinus surgery (FESS). METHODS A total of 42 patients with unilateral chronic rhinosinusitis who underwent unilateral FESS between April 2016 and November 2017 were enrolled. Questionnaires on sinonasal symptoms and nasality were recorded. The change in the nasalance score of vowels [a], [i] [u], nasal consonant [m], 2 nasal syllable repetitions, and 2 Chinese sentences were measured. The patients were evaluated preoperatively, 6 months, and 12 months after the operation. The patients were divided into two groups, wide opening surgery and limited surgery, according to the severity of the disease. RESULTS Among 42 patients, the subjective reports showed that one-third of unilateral chronic rhinosinusitis (CRS) patients had abnormal nasality preoperatively and significant improvement following FESS. The Lund-Mackay score was significantly negatively correlated with preoperative nasalance of [i] and positively correlated with change of nasalance of [i]. The increase in the value of [i] is statistically significant (p = 0.01) following FESS. In the further subgroup analysis, the change in nasalance was significant in the wide opening surgery group, but not in the limited surgery group. CONCLUSION Although only one side of the nasal airway was involved, one-third of the patients reported abnormal nasality. In patients with more disease severity who underwent wide opening surgery, the nasalance significantly increased 1 year after FESS. The increase in the objective nasalance score was corresponded to a significant improvement of subjective self-reported nasality assessment postoperatively.
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Affiliation(s)
- Kun-Lin Yang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Dean Luo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ming-Hsien Tsai
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Tajen University College of Pharmacy and Health Care, Pingtung, Taiwan
| | - Yi Chang
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center of Audiology and Speech-language Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Huei-Yi Kuo
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wei-Chih Chen
- Department of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Tajen University College of Pharmacy and Health Care, Pingtung, Taiwan.
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Valsamidis K, Printza A, Constantinidis J, Okalidou A, Triaridis S. Nasalance and perceived voice changes in patients undergoing septoplasty and turbinate hypertrophy reduction. Eur Arch Otorhinolaryngol 2021; 279:1899-1910. [PMID: 34125283 DOI: 10.1007/s00405-021-06937-9] [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: 04/05/2021] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
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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Affiliation(s)
- Konstantinos Valsamidis
- 1st Otolaryngology Department, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Athanasia Printza
- 1st Otolaryngology Department, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Jannis Constantinidis
- 1st Otolaryngology Department, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece
| | - Areti Okalidou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Otolaryngology Department, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 54124, Thessaloniki, Greece.
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Shetty V, Thejaswi D, Biniyam K, Aroor R, Bhat V, Saldanha M. The effect of functional endoscopic sinus surgery on nasal resonance. World J Otorhinolaryngol Head Neck Surg 2021; 8:269-273. [PMID: 36159900 PMCID: PMC9479475 DOI: 10.1016/j.wjorl.2021.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background and objective Functional endoscopic sinus surgery (FESS) increases the nasal volume, and thereby it can alter the nasal resonance. The objectives were to measure the percentage of nasal resonance following FESS and compare it with healthy individuals with normal nasal findings. Methods The nasometric analysis of voice was done using n/p/m consonant sounds in 72 individuals with healthy post FESS cavities (group 1) and 72 healthy individuals with normal nasal findings without any nasal pathology (group 2). The scores of nasal resonances were expressed in percentages and were compared between the two groups. Both in group 1 and group 2, 32 (44.4%) were females, and 40(55.6%) were males. In group 1, 51 participants had bilateral FESS cavities, and 21 had unilateral FESS cavities. Kannada was the mother tongue in 30 (41.7%) participants in group 1 and 36 (50.0%) in group 2. Malayalam was the mother tongue in 42(58.3%) participants in group 1 and 36 (50.0%) in group 2. Results In both cases and control groups, more than 80% of the participants were showing less than 20% of nasal resonance. In group 1, the mean values of/n/p/m sounds were 11.23%, 10.23% and 11.42% respectively, and in group 2 the mean values were 8.27%, 8.58% and 8.58% respectively. But the P value was not statistically significant. Individuals with unilateral FESS cavities had more nasal resonance values compared to bilateral FESS cavities. Similarly, Kannada speaking people had more values compared to Malayam speaking individua. Conclusion Changes in nasal resonance after FESS is minimal, and it is unnoticed. But it may affect the speech quality in professional voice users, depending on their language. Though the nasometer is considered as the most validated instrument to record nasal resonance, we feel that further standardization is needed to evaluate the nasalance.
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Xiao CC, Luetzenberg FS, Jiang N, Liang J. Does Nasal Surgery Affect Voice Outcomes? A Systematic Review with Meta-Analyses. Ann Otol Rhinol Laryngol 2020; 129:1174-1185. [PMID: 32525399 DOI: 10.1177/0003489420933290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Changes in airflow dynamics after nasal surgery may have implications on voice quality. Multiple studies have evaluated the impact of nasal surgery on voice using heterogeneous outcome measures. We aim to systematically review the impact of nasal surgery on voice quality. METHODS Our study design was a systematic review with meta-analyses. A literature search of PubMed, Ovid, Cochrane from 1997 to 2017 was performed. Inclusion criteria included English language studies containing original data on nasal surgery and voice. Two investigators independently reviewed all manuscripts and performed a comprehensive quality assessment. Meta-analysis was completed on quantitative voice measurements. RESULTS Of 463 identified, 19 studies with 692 patients fulfilled eligibility. Nasal surgeries performed included endoscopic sinus surgery (11/20), septoplasty (11/20), rhinoplasty (2/20), and turbinate reduction (2/20). Voice outcomes measured included nasalance (8/20), fundamental frequency (11/20), jitter (10/20), shimmer (10/20), harmonic to noise ratio (HRN) (8/20), formants (5/20), and voice handicap index (VHI) (4/20). Voice examinations were assessed preoperatively and 1 to 30 months postoperatively. Meta-analysis revealed statistically significant changes in nasalance, (P < .01) 1 month postoperatively; there was no significant difference in nasalance at 6 months postoperatively. All other variables analyzed revealed no statistically significant differences. Five of nine studies showed majority of patients did not notice subjective change in voice after surgery, but with high heterogeneity of measurements. CONCLUSIONS There may be a short-term increase in nasalance that resolves at longer follow-up, but there seem to be no other objective changes in voice. There may be subjective changes after surgery, but require further study to evaluate.
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Affiliation(s)
- Christopher C Xiao
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | | | - Nancy Jiang
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jonathan Liang
- Head and Neck Surgery Department, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Abstract
BACKGROUND Septoplasty is a surgical technique for the correction of the nasal septum that may alter the vocal tract. The aim of our study is to assess whether this technique modifies nasalance and acoustic parameters, and their clinical implications in voice perception. METHODOLOGY A prospective study was performed between January 2017 and June 2017 including 2 groups of patients: those undergoing septoplasty, and a control group. Subjective nasality questionnaire, objective nasalance with nasometer, and GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) assessment were statistically analysed. In addition, a recording of patients' voices was made with a subsequent acoustic analysis. Samples were taken: pre-surgically, 2 weeks after surgery and after 3 months. RESULTS After septoplasty, a significant difference was observed in GRBAS, nasality questionnaire and nasometer nasalance, when compared with the control group. As for the acoustic analysis, no differences were observed in most parameters (F0, Jitter, Shimmer, HNR, NHR, Formants F1-F3), except for the antiF3 antiformant, which showed significant changes in all the vowels studied. CONCLUSIONS Septoplasty can produce changes in the vocal tract, with an increase in initial nasalance but with subsequent normalization. Besides, minor changes were found in the acoustic analysis but with no clinical relevance.
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