Speech changes following uvulopalatopharyngoplasty

Do Pharyngeal Surgeries for Snoring and Obstructive Sleep Apnea Have an Impact on Nasalance Scores?

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.

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.

The effect of radiofrequency volumetric tissue reduction of soft palate on voice

The surgical techniques used for snoring and OSA treatment include partial/complete resection or tissue reduction of the oropharyngeal structures such as uvula, tonsilla palatinas, soft palate, lateral pharyngeal tissues and tongue base. So it is predictable for these techniques to affect the resonating volume of the vocal tract and therefore the speech sounds. The goal of this study was to evaluate whether radiofrequency volumetric tissue reduction (RFVTR) of the soft palate can cause voice changes by altering the formant frequencies and fundamental frequency of vowels. A prospective study of 26 habitual snorers and mild obstructive sleep apnea patients (apnea-hypopnea index, <10 in all cases) were investigated before and 6 weeks after RFVTR. The patients received one Somnoplasty RFVTR treatment of 1,400 J per treatment session: 700 J into the midline and 350 J on each side of the soft palate with a maximum temperature of 80 degrees C. Acoustic evaluation was made by the Multidimensional Voice Program. The mean fundamental frequency (MF0) and the first three formant frequencies (F1, F2, F3) of four sustained vowels /a/, /e/, /i/ and /o/ were determined. Comparison between preoperative and postoperative acoustic analysis of the MF0 and F1, F2, F3 of sustained vowels revealed no significant change. The findings of the study indicate that RFVTR of the soft palate as a treatment for snoring and mild forms of OSA does not have a significant impact on the mean fundamental frequency and formant frequencies of vowels. These results seem to be important in management of patients with concerns about postoperative vocal quality, such as singers and professional speakers.

Nasalance, nasality, voice, and articulation after uvulopalatopharyngoplasty

OBJECTIVES/HYPOTHESIS

The main purpose of the study was to determine the impact of uvulopalatopharyngoplasty (UPPP) on nasalance and nasality. It was hypothesized that nasalance would change from the presurgical to the postsurgical condition because the surgical protocol involves removal of palatal tissue. An additional objective of the study was to provide objective and subjective data about changes in voice and articulation after UPPP. Because the surgical procedure of UPPP does not involve laryngeal tissue, it was hypothesized that the voice characteristics remain relatively stable. Because of removal of effective velar length, articulation problems of the uvular /R/ can occur in the Dutch language.

STUDY DESIGN

Prospective study in which 26 men were studied before (1 week before UPPP) and after (3 weeks after UPPP) surgery.

METHODS

The Nasometer was used to obtain nasalance scores. The mirror-fogging test, a perceptual evaluation of each subject's readings, and the Gutzmann and the Bzoch hypernasality tests were used for the assessment of nasality. For the assessment of articulation, a phonetic analysis was performed. Voice assessment included a perceptual rating of the voice and a determination of fundamental frequency.

RESULTS

No significant differences were found between the conditions before and after surgery regarding nasalance (except for the vowel /i/), nasality, and voice. Regarding articulation, only 1 patient showed a derhotacized /R/.

CONCLUSIONS

The findings of the study indicate that UPPP does not have an impact on nasality, voice, and articulation. Regarding nasalance, no significant nasalance change occurred after UPPP, except for the high vowel /i/.