Effects of Nasal Obstruction due to Nasal Polyposis on Nasal Resonance and Voice Perception

Abstract

Objective: The aim of this study was to use subjective and objective methods to investigate the effects of total or nearly total nasal obstruction due to nasal polyposis on nasal resonance and voice perception. Patients and Methods: A total of 63 nasal polyposis patients (53 men and 10 women), aged between 19 and 72 years (mean age 37.01 ± 13.70), were included in the study. The severity of the nasal obstruction was assessed using a visual analog scale. Nasal resonance and voice perception were evaluated subjectively by the voice handicap index (VHI)-10 questionnaire and objectively by computerized analysis (nasometry) before and after treatment of patients with nasal polyposis. Results: Significant improvement was seen in the nasal obstruction values in all patients (100%; p < 0.001) and in the VHI-10 scores in 62 patients (98%; p < 0.001). Nasalance scores increased in all patients following treatment (100%; p < 0.001). Conclusion: Voice perception is negatively affected by nasal obstruction due to nasal polyposis, and changes in voice perception may arise after the surgery. Before the surgery, informing the patient about potential voice perception changes may be useful for the prevention of legal disputes.

Does Nasal Surgery Affect Voice Outcomes? A Systematic Review with Meta-Analyses

“…A total of 483 unique articles resulted from the initial query and bibliography selection. Upon review, 19 studies with 697 patients were eligible to be included in qualitative assessment (Figure 1); these included six case-control studies 3,12-16 with a total of 169 patients and 13 case series studies 2,5-9,17-23 with a total of 523 patients. Eight studies qualified for quantitative review.…”

“…2,3,5,6,8,16,19,20 Outcome measures included nasalance scores, formant scores, scores of F0, jitter, shimmer, and HNR, and patient voice perception scores. Based on initial diagnosis, seven studies investigated patients with chronic rhinosinusitis (CRS), 5-9,17,21 nine studies included patients with a deviated nasal septum (DNS), 2,6,8,12,14-16,19,20 three studies included nasal polyposis, 13,18,23 one study examined inferior concha hypertrophy, 3 and one study selected patients with internal nasal valve collapse. 22 In terms of surgical procedures, 10 studies performed functional endoscopic sinus surgery, 5-9,13,17,18,21,23 11 studies performed septoplasty, 2,5,6,8,9,12,14-16,19,20 two studies performed rhinoplasty, 9,22 and two studies performed turbinectomy.…”

“…26 The majority (6/8) of these studies found a significant change in nasalance in the nose at 1 to 3 months postoperatively. 5-8,13,23 Considering that many of these surgeries relieve obstruction, and therefore allow for easier passage of vocal energy through the nose, this finding seems reasonable. Of interest however, is that in the majority (3/4) of the studies with longer follow-up, this difference seems to no longer be significant at 6 months postoperatively, which is corroborated by the meta-analysis.…”

“…14 Of note, however, two of the four studies could not be included in the meta-analysis due to lack of reporting of standard deviations. 14,23 There remains significant variability in the subjective results. For example, one study reported a significant change via third party evaluation but also noted that most patients did not notice a change until told by others.…”

“…Nasalance was measured in eight of the selected articles and obtained using a Nasometer instrument. [5][6][7][8]13,16,21,23 Nasalance was primarily assessed in terms of hyper-nasality and hypo-nasality, using nasal and oral sentences/passages (7/8), respectively. 5,6,8,13,16,21,23 Another measure of nasalance was through the usage of nasal vowels (a, i, and u) and nasal consonants (m and n) (5/8).…”