The potential effects of rhinoplasty on voice

Overview

The nose is part of the vocal tract, so narrowing it can change how a voice sounds. This study from Iran measured voice in patients undergoing rhinoplasty using a patient questionnaire, listener ratings and acoustic recordings. Testing was done before surgery and again five months afterward.

Sections of note

• Twenty-seven patients were studied, each acting as their own comparison.
• Patients completed the Voice Handicap Index, and perceptual plus acoustic analyses were performed.
• Assessment points were before surgery and five months after surgery.
• Voice Handicap Index total score and its physical and emotional subscales rose significantly, meaning worse self rated voice.
• Blind ratings by six trained listeners showed a significant increase in hyponasality.
• Acoustic analysis showed the frequency of the first and second nasal murmurs rose for the sounds m and n while their amplitude fell, with the same pattern for the vowel in the word man.
• The paper is graded therapeutic level of evidence IV.

What it means for a patient

• Rhinoplasty can measurably change the sound of the voice, mainly by making it less nasal.
• The authors state the changes are not generally troublesome for most patients, but people who depend on their voice at work should discuss them before surgery.
• This was a small single group study with no untreated comparison group, and testing stopped at five months, so longer term recovery was not measured.

Why this paper matters

It puts numbers on a side effect of rhinoplasty that is rarely raised in consultation. It does not establish how often voice change is noticeable in ordinary speech, or whether professional voice users are affected more than others.

Terms

• Voice Handicap Index: a questionnaire in which patients rate how much their voice affects daily life.
• Hyponasality: a blocked or muffled voice quality from too little air resonating in the nose.
• Acoustic analysis: computer measurement of the frequency and loudness of recorded speech.
• Nasal murmur: the low resonant sound produced in the nose during consonants such as m and n.
• Vocal tract: the airway from the voice box through the throat, mouth and nose that shapes speech sounds.