Sinusitis Patients Voice Resonance following Endoscopic Surgery
It is estimated that some 37 million Americans suffer from allergic rhinitis and sinusitis each year. Many do not seek treatment; most find relief through prescription and over-the-counter medications. A minority of this population comes to the conclusion that medication is not a solution and seeks relief through endoscopic surgery. But the relief from sinusitis may have a cost – the quality of the voice.
A great voice has great resonance, affected by the body’s supraglottic area, pharynx, oral cavity, nasal cavity and paranasal sinuses. When minor alterations occur in the configuration of these anatomical structures, the result could be substantial differences in vocal quality.
Although the role of the nasal cavity and paranasal sinuses in vocal quality remains uncertain, disorders of nasal resonance may be described in two categories: excessive nasality and insufficient nasality. Anecdotally, patients who have undergone surgery for chronic sinusitis commonly note a change in their speech quality. However, a comprehensive review of the medical, speech, and acoustic literature failed to identify any studies addressing the effects of sinus surgery on speech.
The effect of endoscopic sinus surgery on the voice is examined for the first time in a research study, “Speech Changes After Functional Endoscopic Sinus Surgery,” authored by Hany Amin Riad, MD, Azab Ahmed El Azab, MD, Mona Abd El Fattah Hegazy, MD, Mohsen Abd El Razek, MD, and Hassan Ibrahiem, [MD?]all from the Otolaryngology Department Benha Faculty of Medicine Zagazig University, Phoniatrics Department, Ain Shams University, Cairo, Egypt. Their findings are being presented at the American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting & OTO EXPO, being held September 19-22, 2004, at the Jacob K. Javits Convention Center, New York City, NY.
Methodology: This study involved 30 patients and ten control subjects. The patients included 18 males with age range of 17-41 years (mean age = 33 years) and 12 females with age range 17-45 years (mean age = 32 years) all without ear and throat problems, speech disorders, or previous nasal or sinus surgery. The control subjects included five males and five females with age range 20-45 years (mean age 31 years) with no history of nasal, sinus, or speech problems. The patients were prepared to undergo functional endoscopic sinus surgery (FESS) for chronic sinusitis.
A patient questionnaire with a ten point visual analog scales (VASS) was completed by each patient to subjectively assess the degrees of nasal obstruction, speech changes, and degree of patient satisfaction. Before endoscopic surgery, the pathology of the patients’ nose and sinuses was classified into five stages, with the first two stages indicating moderate disease and the third and fourth stage providing evidence of severe pathology.
Results: This study is a trial to use objective data from nasometery, nasal flow ml/once, and nasal sound pressure level and subjective data from the questionnaire about nasal obstruction and speech changes to estimate changes in speech before and after FESS. Key findings were:
The nasalance [define] score (defining the quality of the voice produced by nasal resonators) for the nasal sentence (mama, manal) showed a highly significant difference between pre and postoperative results and control results (Pre -47.15 percent, post 58.34-percent and control, 56.91 percent). This increase indicates improvement in the nasal resonance of speech sounds in patients after FESS.
Comparison of the change in the mean nasal sentences (O/C) nasal pressure, and nasal air flow in patients pre- and postoperative according to sex and age were insignificant. These results prove that age and sex factors are non-contributing factors for the surgical results.
Patients who had FESS plus partial resection of inferior turbinate showed highly significant results. Patients without resection of inferior turbinate showed significant results. (This is because resonance of speech in the nose occurs mainly in the posterior nasal area and when there is enlargement of the inferior turbinate there is decrease of the space needed for good resonance so partial resection of the hypertrophied inferior turbinate will improve nasal hyponasality.)
Comparing the results of the patient questionnaire pre and postoperatively revealed a highly significant response indicating a subjective perception of significant improvement in speech and nasal obstruction. Approximately 60 percent of the patients indicated changes in vocal quality and nasal obstruction after surgery.
Conclusions: The researchers conclude that there are significant changes in nasal resonance for patients with chronic sinusitis and nasal obstruction treated with functional endoscopic sinus surgery (FESS). These changes show improvement of the degree of hyponasality of the patients to match the range of nasality of normal subjects.
These changes are affected by degree of pathology and type of surgical procedure; more improvement was seen in patients with severe pathology and partial resection of the inferior turbinate than patients with mild to moderate pathology and no resection of the inferior turbinate. While improvement following surgery was noted, the researchers caution that patients using their voice professionally should be advised regarding the possible effects of FESS on vocal quality. Surgeons treating such individuals should be highly conservative during surgery and turbinate excision.