Voice Assessment Pre- and Post-Adenotonsillectomy in Children.

Document Type : Original Article

Authors

1 Departmentof Otorhinolaryngology, Faculty of Medicine, Minia University.

2 Audiology Department,Faculty of Medicine, Minia University.

3 Department of Audiology ,Faculty of Medicine, Minia University.

4 Department of Otorhinolaryngology , Faculty of Medicine, Minia University.

Abstract

Objective
Changes in vocal patterns after adenotonsillectomy are questionable. Few studies have assessed acoustic voice changes before and after adenotonsillectomy. The objective of this study wasto evaluate the impact of adenotonsillectomy on the voice of children with adenotonsillar hypertrophy.
Participants and Methods
The study included fifty children ranging in age between 4 and 12 years, with adenotonsillar hypertrophy, indicated for adenotonsillectomy. Auditory perceptual assessment of speech included nasality, degree of hyponasality, degree of open nasality, and degree of dysphonia. Acoustic analysis was carried out before and after one month and three months of surgery, using multidimensional voice program software (MVDP). The vowels were analyzed as to their acoustic parameters: fundamental frequency (Hz), jitter (%), shimmer (dB) and noise-harmony ratio (NHR; dB).
Results
At oneand threemonths after surgery, preoperative readings were of F0 score while jitter and shimmer normalized only at the 3rd month. There were significant differences between readings at one month and threemonths of F0 and jitter. Auditory perceptual assessment(APA) of voice (dysphonia) and APA of speech (hyponasality) significantly improved at 1st and 3rd month after surgery with significant differences between results of 1st and 3rd month. Harmonic noise ratio (HNR) had negative, significantly fair correlation with APA of Voice (dysphonia). 
Conclusion
Hyponasal speech and with dysphonia preoperatively often have normal resonance and voice following adenotonsillectomy. Objective and subjective evaluation of speech and voice can help the specialist in the management of patients with adenotonsillar hypertrophy.
 

 

Highlights

 

Keywords


  1. Dimatos SC, Neves LR, Beltrame JM, Azevedo RR, Pignatari SS. Impact of adenotonsillectomy on vocal emission in children. Braz J Otorhinolaryngol. 2016;82(2):151-8.
  2. Mora R, Crippa B, Dellepiane M, Jankowska B. Effects of ade-notonsillectomy on speech spectrum in children. Int J PediatrOtorhinolaryngol. 2007;71:1299-304.
  3. Wallner LJ, Hill BJ, Waldrop W, Monroe C. Voice changes following adenotonsillectomy. A study of velar function by cinefluorography and video tape. Laryngoscope 1968;78:1410-8.
  4. Andreassen ML, Leeper HA, MacRae DL, Nicholson IR. Aerodynamic, acoustic, and perceptual changes following adenoidectomy. Cleft Palate Craniofac J 1994;31:263-70.
  5. Nemr K, Amar A, Abrahão M, Leite GC, Köhle J, Santos Ade O, et al. Comparative analysis of perceptual evaluation, acoustic analysis and indirect laryngoscopy for vocal assessment of a population with vocal complaint. Braz J Otorhinolaryngol 2005;71:13-7.
  6. Lundeborg I, Hultcrantz E, Ericsson E, McAllister A. Acoustic and Perceptual Aspects of Vocal Function in Children with Adenotonsillar Hypertrophy—Effects of Surgery. J Voice.2012; 26:480-487.
  7. Shokouhi F, MeymanehJahromi A, Majidi MR, Salehi M. Montelukast in Adenoid Hypertrophy: Its Effect on Size and Symptoms. Iranian Journal of Otorhinolaryngology. 2015;27(83):443-448.
  8. Pannbacker M. Velopharyngeal Incompetence: The Need for Speech Standards. American Journal of Speech-Language Pathology. 2004;13:195-201.
  9. Kara M, Öztürk K, Özer B. An evaluation of the effects of adenoidectomy on voice and speech function in children. Kulak BurunBogazIhtisDerg. 2013 Jul-Aug;23(4):225-31.
  10. Chuma AV, Cacace AT, Rosen R, Feustel P, Koltaii PJ. Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics. Int J PediatrOtorhinolaryngol. 1999 Jan 25;47(1):1-9.
  11. Salami A, Jankowska B, Dellepiane M, Crippa B, Mora R. The impact of tonsillectomy with or without adenoidectomy on speech and voice.Int J PediatrOtorhinolaryngol. 2008 Sep;72(9):1377-84.
  12. Van Lierde KM, Wuyts FL, De Bodt M, Van Cauwenberge P. Age-related patterns of nasal resonance in normal Flemish children and young adults. Scand. J. Plast. Reconstr. Surg. Hand Surg. 2003;37:344-350.
  13. Klatt DH, Klatt LC. Analysis, synthesis, and perception of voice quality variation among female and male talkers. J AcoustSoc Am. 1990;87(2):820-857.
  14. Subramaniam V, Kumar P. Impact of tonsillectomy with or without adenoidectomy on the acoustic parameters of the voice: a comparative study. Arch Otolaryngol Head Neck Surg. 2009 Oct;135(10):966-9.