Acoustic and Perceptual Aspects of Vocal Function in Children With Adenotonsillar Hypertrophy—Effects of Surgery

Abstract

Objective: To evaluate outcome of two types of tonsil surgery (tonsillectomy+adenoidectomy or tonsillotomy +adenoidectomy) on vocal function perceptually and acoustically.Study Design: Sixty-seven children, aged 50-65 months, on waiting list for tonsil surgery were randomized to tonsillectomy (n=33) or tonsillotomy (n=34). Fifty-seven age and gender matched healthy pre-school children were controls. Twenty-eight of them, aged 48-59 months, served as control group before surgery, and 29, aged 60-71 months, after surgery Methods: Before surgery and six months postoperatively, the children were recorded producing three sustained vowels (/, , ) and 14 words. The control groups were recorded only once.Three trained speech and language pathologists performed the perceptual analysis using Visual Analogue Scales (VAS) for eight voice quality parameters. Acoustic analysis from sustained vowels included average fundamental frequency, jitter percent, shimmer percent, noise-to-harmonic ratio and the centre frequencies of formants 1-3Results: Before surgery the children were rated to have more hyponasality and compressed/throaty voice (p<0,05) and lower mean pitch (p<0,01) in comparison to the control group. They also had higher perturbation measures and lower frequencies of the second and third formant. After surgery there were no differences perceptually. Perturbation measures decreased but were still higher compared to the control group's, p<0, 05.Differences in formant frequencies for // and / remained. No differences were found between the two surgical methods.Conclusion: Voice quality is affected perceptually and acoustically by adenotonsillar hypertrophy. After surgery the voice is perceptually normalized but acoustic differences remain. Outcome was equal for both surgical methods.

Assessment of Effects of Septoplasty on Acoustic Parameters of Voice: A Prospective Clinical Study

“…Studies on voice have gained importance in the current century, and phonosurgery techniques have begun to improve. Voice is formed as a result of the coordination between many systems, particularly respiratory, neurology, muscle-skeleton, and endocrine systems (8)(9)(10). The harmony and coordination between the vocal cords and respiratory system are necessary for the formation of voice.…”

“…Nasal septal deviation causes a decrease in the amount of air from the velopharyngeal regions, which are open during speech, and the nasopharynx into the nasal cavity. Upper respiratory tract surgeries, such as septoplasty, turbinectomy, and uvulopalatopharyngoplasty, will lead to resonance changes in the formation of voice (10)(11)(12)(13)(14).…”

Análise vocal na infância: uma revisão integrativa

“…A qualidade vocal de crianças com obstrução de via aérea superior tem grau aumentado de hiponasalidade, pitch mais grave e voz comprimida. Na avaliação acústica, observa-se que a f0 é menor no grupo com obstrução nasal crônica e as medidas jitter, shimmer e PHR se apresentaram melhores no grupo sem obstrução nasal 1, 28,29 .…”

Effect of Rapid Maxillary Expansion on Voice

“…Surgeries of the upper airway such nasal surgery, uvulopalatopharyngoplasty, and tonsillectomy with or without adenoidectomy have all been proven to affect to a minor extent variant formant frequencies with conflicting results. 22,23 The effect has been attributed to changes in the acoustic surface area induced by surgery and hence to alterations in the resonant characteristics of the resonators and their coupling effect in transmitting sound. The anatomical alterations following extirpation of soft tissues can also affect vocal tract resonance by inducing changes in the dynamic behavior of the vocal tract muscular wall.…”