Summary
Objective
Singers undergoing tonsillectomy are understandably concerned about possible sequelae
to their voice. The surgical risks of laryngeal damage from intubation and upper airway
scarring are valid reasons for singers to carefully consider their options for treatment
of tonsil-related symptoms. No prior studies have statistically assessed objective
voice outcomes in a group of adult singers undergoing tonsillectomy. This study determined
the impact of tonsillectomy on the adult singing voice by determining if there were
statistically significant changes in preoperative versus postoperative acoustic, aerodynamic,
and Voice-Related Quality of Life (VRQOL) measures.
Study Design
Prospective cohort study.
Setting
Tertiary Referral Academic Hospital
Subjects
Thirty singers undergoing tonsillectomy from 2012 to 2019.
Methods
Acoustic recordings were obtained with Computerized Speech Lab (CSL) (Pentax CSL 4500)
and analyzed with the Multidimensional Voice Program (MDVP) (Pentax MDVP) and Pratt
Acoustic Analysis Software. Estimates of aerodynamic vocal efficiency were obtained
and analyzed using the Phonatory Aerodynamic System (Pentax PAS 6600). Preoperative VRQOL scores were recorded, and singers were instructed to refrain
from singing for 3 weeks following tonsillectomy. Repeat acoustic and aerodynamic
measures as well as VRQOL scores were obtained at the first postoperative visit.
Results
Average postoperative acoustic (jitter, shimmer, HNR) and aerodynamic (sound pressure
level divided by subglottal pressure) parameters related to laryngeal phonatory function
did not differ significantly from preoperative measures. The only statistically significant
change in postoperative measures of resonance was a decrease in the 3rd formant (F3)
for the /a/ vowel. Average postoperative VRQOL scores (79.8, SD18.7) improved significantly
from preoperative VRQOL scores (89, SD12.2) (P = 0.007).
Conclusions
Tonsillectomy does not appear to alter laryngeal voice production in adult singers
as measured by standard acoustic and aerodynamic parameters. The observed decrease
in F3 for the /a/ vowel is hypothetically related to increasing the pharyngeal cross-sectional
area by removing tonsillar tissue, but this would not be expected to appreciably impact
the perceptual characteristics of the vowel. Singers’ self-assessment (VRQOL) improved
after tonsillectomy.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Clinical practice guideline: tonsillectomy in children (Update)-executive summary.Otolaryngol Head Neck Surg. 2019; 160: 187-205
- Ambulatory surgery in the United States, 2006.Natl Health Stat Report. 2009; : 1-25
- Adenotonsillectomy complications: a meta-analysis.Pediatrics. 2015; 136: 702-718
- Effects of tonsillectomy and/or adenoidectomy on vocal function: laryngeal, supralaryngeal and perceptual characteristics.Int J Pediatr Otorhinolaryngol. 1999; 47: 1-9
- Does tonsillectomy affect voice in early or late postoperative periods in adults?.J Voice. 2017; 31: 131-138
- The impact of tonsillectomy with or without adenoidectomy on speech and voice.Int J Pediatr Otorhinolaryngol. 2008; 72: 1377-1384
- Acoustic analysis of voice in post-tonsillectomy patients.Bangladesh J Med Sci. 2018; 17: 382-387
- Changes in acoustic aspects of vocal function in children after tonsillectomy.J Voice. 2020; (In Press)
- Acoustic analysis of voice in tonsillectomy.J Voice. 1989; 3: 81-86
- Tonsillectomy and adenoidectomy in singers.J Voice. 2001; 15: 561-564
- Validation of an instrument to measure voice-related quality of life (V-RQOL).J Voice. 1999; 13: 557-569
- Determination of the geometry of the human vocal tract by acoustic measurements.J Acoust Soc Am. 1967; 41: 1002-1010
- The relations between area functions and the acoustic signal.Phonetica. 1980; 37: 55-86
- Acoustic Phonetics.MIT Press, Cambridge MA1998
- Impact of tonsillectomy with or without adenoidectomy on the acoustic parameters of the voice: a comparative study.Arch Otolaryngol Head Neck Surg. 2009; 135: 966-969
- The effects on the acoustic parameters and auditory-perceptive characteristics of voice in children submitted to adenoidectomy with or without tonsillectomy.Int J Pediatr Otorhinolaryngol. 2019; 125: 51-55
- Effects of tonsillectomy on speech and voice.J Voice. 2009; 23: 614-618
- Thermal welding vs. cold knife tonsillectomy: a comparison of voice and speech.Int J Pediatr Otorhinolaryngol. 2011; 75: 114-117
- Quality of life after tonsillectomy in adults with recurrent or chronic tonsillitis.Otolaryngol Head Neck Surg. 2008; 138: S1-S8
- Assessment of clinical improvement and quality of life before and after tonsillectomy.J Laryngol Otol. 2009; 123: 199-202
Article info
Publication history
Published online: October 31, 2020
Accepted:
September 30,
2020
Footnotes
No financial support or funding was obtained or used in this study or in the preparation of this manuscript.
Identification
Copyright
© 2020 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
