Letter to Editor on “Changes in Acoustic Aspects of Voice Function in Children After Adenotonsillectomy”

We read with great interest the article by Brkic et al on changes in Acoustic Aspects of Vocal Function in Children After Adenotonsillectomy. They have reported significant differences in the fundamental frequency, jitter, shimmer and harmonic noise ratio immediately after surgery. Of these the fundamental frequency was the earliest to return to normal in one month. This finding is used to allay the concerns of the parents regarding voice change. We commend the authors for sharing their valuable experience with voice change after adenotonsillectomy. However, we believe that nasalance is an important component of voice and change in nasalance can affect voice quality perceived by the parents. This has not been commented by the authors. We would like to share our preliminary experience with 27 children who underwent adenotonsillectomy for chronic adenotonsillitis at our center. Pre and 1 month postoperative nasalance was measured in these children with the Nasal View (Tiger Electronics Inc, Seattle, Washington).The children were asked to repeat six standardized sentences (two oral, two nasal and two oro-nasal sentences) in their normal pitch, rate and loudness and the mean of three readings was calculated. The average age of children in our study was 6.4 years (5.2-7.6 yrs) and the male female ratio was 1.25:1. Analysis of the pre and post op scores by paired t test showed a significant increase change in nasalance after surgery in oral, oronasal and nasal sentences with p values highly significant for nasal and oronasal sentences(P = <0.001) (Table 1). While an increase in nasality has been reported after adenoidectomy, the results after tonsillectomy are conflicting. ^{,  ,}  Adenotonsillectomy is a common surgery in childhood .Parents often have major apprehensions about its post-operative complications especially regarding voice change. A study with similar objectives as the authors published by Inja et al from our center found no objective changes in voice parameter after surgery but subjective assessment by the Pediatric Voice Outcome Score questionnaire showed significant change in voice quality. Our preliminary results demonstrate that there is a change in nasalance after adenotonsillectomy which could explain the change in subjective measures of voice change. Liu et al also did not note any change in voice acoustic index after surgery but noted positive changes in the aerodynamic function. Voice is a function of sound generators, sound vibrators and sound resonators. We recommend that including nasalance in voice evaluation will help the ENT fraternity to better address the concerns of parents regarding voice change after adenotonsillectomy.