Is Adenotonsillar Size a Significant Factor on Voice in Children Undergoing Adenotonsillectomy?

Abstract

Methodology: A total of 57 patients, who have been diagnosed with chronic adenotonsillitis and operated for obstruction or infection, were included in the study. Patients were divided into two groups according to their palatine tonsil sizes. Each patient performed voice analysis preoperatively and one month postoperatively, recruiting both objective and subjective methods. F0, jitter % and shimmer % values were assessed with objective methods; while subjective methods evaluated pediatric voice handicap index (pVHI) scores. Pre-and post-operative F0, jitter % and shimmer % values and pVHI scores from each study group were compared. Results: In each study group, pre-and post-operative F0, jitter % and shimmer % values were found to be similar. In Group A, postoperative pVHI scores were found to be significantly reduced (p<0.001). In Group B, however, pre-and postoperatively assessed pVHI scores were similar. Conclusion: Adenotonsillar hypertrophy in children, who underwent adenotonsillectomy, seems to be an important and positively effecting factor on the subjective, but not the objective, parameters of voice.

Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta‐Analysis

“…40,41 The softwares used in the included studies were the Computerized Speech Lab, 12,24,29 the Multi-Dimensional Voice Program, [13][14][15]22,24,41 the standardized commercial voice analysis system, 16 the Praat software, 23,26,28,41 and the XION Medical DIVAS 2.5 Digital Voice Analysis. 25 The aerodynamic assessment includes the transglottic flow and the subglottic pressure to understand the variations in pressure and airflow during vocal fold vibration. The equipment used in the included studies was the Phonatory Aerodynamic System.…”

“…One method was clinical evaluation by a speech-language pathologist [12][13][14][15][16][17][18][19]23 or otolaryngologist. 27,28 The other was a caregiver assessment questionnaire, which comprised the Pediatric Voice Handicap Index, 15,25,27,29 Pediatric Voice Outcome Survey, 26 and visual analog scale. 29…”

“…The characteristics of the 23 studies were shown in Table I, with a total of 2154 patients analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Among these studies, ten studies were from Asia, 16,[20][21][22][24][25][26][27]29,30 nine studies were from Europe, 11,[13][14][15]17,28,[31][32][33] two study from South America, 18,23 one study from Africa, 19 and one study from the United States. 12 Five studies enrolled a normal control group.…”

“…14,16,17,20,33 For computerized acoustic voice analysis, three studies used the Computerized Speech Lab, 12,24,29 five studies used the Multi-Dimensional Voice Program, [13][14][15][16]24 one study used the standardized commercial voice analysis system, 16 one study used the Phonatory Aerodynamic System, 22 three studies used the Praat software, 23,26,28 and one study used the XION Medical DIVAS 2.5 Digital Voice Analysis. 25 For subjective clinical evaluations, four studies were evaluated by speech therapists, 12,14,15,23 and two studies were evaluated by otolaryngologists. 27,28 The subjective caregiver assessment questionnaire, four studies used the Pediatric Voice Handicap Index, 15,25,27,29 one used the Pediatric Voice Outcome Survey, 26 and one used the visual analog scale.…”

The effect of tonsillectomy on voice quality

“…Part of the studies suggest that hypertrophic tonsils have hypernasality as a concomitant symptom that decreases postoperatively and thus leads to an improvement of voice quality [10]. However, some studies have shown that after tonsillectomy, only a subjective experience of voice improvement occurs, but this is not confirmed by objective measurements [11,12].…”