The Effects of Anterior Palatoplasty and Functional Expansion Sphincter Pharyngoplasty on Voice Quality in Patients with Obstructive Sleep Apnea

Published:January 12, 2023DOI:



      We aimed to examine the effects of anterior palatoplasty (AP) and functional expansion sphincter pharyngoplasty (FESP) on voice quality in patients with OSAS and to compare them with each other.


      The study included 380 patients who came to the Otorhinolaryngology Clinic of our hospital with symptoms of snoring and sleep apnea between April 2020 and April 2022 and were referred to the sleep laboratory for polysomnography (PSG).Forty patients who met the study criteria and underwent AP and 26 patients who underwent FESP were included in the study. All surgeries were performed under general anesthesia by the same otolaryngologist within 1 month at the latest after sleep endoscopy. Acoustic voice analysis was performed using the Praat voice analysis program preoperatively and postoperatively at 6 months. F0, jitter, shimmer, and NHR (noise-to-harmonic ratio) were compared between the groups pre and postoperatively.


      There were 20 females and 20 males in the AP group, 12 females and 14 males in the FESP group, There was no statistically significant difference in sex distribution between the groups (P = 0.952). The difference between the preop and postop F0, jitter, shimmer, and NHR in both the AP and FESP groups was statistically significant (P < 0.01). After AP and FESP surgeries, F0 values ​​increased, jitter, shimmer and NHR values ​​decreased (P < 0.01).F0, jitter, shimmer, and NHR changes were the greatest in the FESP group.(P < 0.01).


      Positive changes in F0, jitter, shimmer, and NHR were greatest in the FESP group significantly. FESP surgery affects voice quality more than AP surgery in patients with OSAS.

      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 access
      One-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 to Journal of Voice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Bilston LE
        • Gandevia SC.
        Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea.
        J Appl Physiol (1985). 2014; 116: 314-324
        • Chung S
        • Yoon IY
        • Shin YK
        • et al.
        Endothelial dysfunction and inflammatory reactions of elderly and middle-aged men with obstructive sleep apnea syndrome.
        Sleep Breath. 2009; 13: 11-17
        • Parish JM
        • Somers VK.
        Obstructive sleep apnea and cardiovascular disease.
        Mayo Clin Proc. 2004; 79: 1036-1046
        • Kushida CA
        • Littner MR
        • Hirshkowitz M
        • et al.
        Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders.
        Sleep. 2006; 29: 375-380
        • Li MX
        • Yan CY
        • Wang S.
        New insights on the role of the insular cortex and habenula in OSA.
        Sleep Breath. 2015; 19: 1347-1353
        • Blumen M
        • Bequignon E
        • Chabolle F.
        Drug-induced sleep endoscopy: a new gold standard for evaluating OSAS? Part II: Results.
        Eur Ann Otorhinolaryngol Head Neck Dis. 2017; 134: 109-115
        • Karakoc O
        • Akcam MT
        • Genc H
        • et al.
        Do pharyngeal surgeries for snoring and obstructive sleep apnea have an impact on nasalance scores?.
        J Craniofac Surg. 2015; 26: 2213-2216
        • Schwab RJ
        • Pack A
        • Gupta HB
        • et al.
        Upper airway and soft tissue struc-tural changes induced by CPAP in normal subjects.
        Am J Respir CritCare Med. 1996; 154: 1106-1116.
        • Sorrenti G
        • Piccin O.
        Functional expansion pharyngoplasty in the treatment of obstructive sleep apnea.
        Laryngoscope. 2013; 123: 2905-2908
        • Pang KP
        • Terris DJ.
        Modified cautery-assisted palatal stiffening operation: new method for treating snoring and mild obstructive sleep apnea.
        Otolaryngol Head Neck Surg. 2007 May; 136: 823-826
        • Han D
        • Xu W
        • Hu R
        • et al.
        Voice function following Han's uvulopalatopharyngoplasty.
        J Laryngol Otol. 2012; 126: 47-51
        • Yeğin Y
        • Çelik M
        • Şimşek BM
        • et al.
        Assessment of effects of septoplasty on acoustic parameters of voice: a prospective clinical study.
        Turk Arch Otorhinolaryngol. 2016; 54: 146-149
        • Xiao CC
        • Luetzenberg FS
        • Jiang N
        • et al.
        Does nasal surgery affect voice outcomes? A systematic review with meta-analyses.
        Ann Otol Rhinol Laryngol. 2020; 129: 1174-1185
        • Shrivastava D.
        Impact of sleep-disordered breathing treatment on upper airway anatomy and physiology.
        Sleep Med. 2014; 15: 733-741
        • Tuhanioğlu B
        • Erkan SO
        • Özdaş T
        • et al.
        The effect of electronic cigarettes on voice quality.
        J Voice. 2019; 33 (811.e13-811.e17)
        • Patel RR
        • Awan SN
        • Barkmeier-Kraemer J.
        Recommended protocols for instrumental assessment of voice: american speech-language-hearing association expert panel to develop a protocol for instrumental assessment of vocal function.
        Am J Speech Lang Pathol. 2018; 27 (PMID:29955816): 887-905
        • 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; 135: 966-969
        • Mora R.
        • Jankowska B.
        • Mora F.
        • et al.
        Effects of tonsillectomy on speech and voice.
        J Voice. 2009; 23: 614-618
        • Greene J.S.
        • Zipfel T.E.
        • Harlor M.
        The effect of uvulopalatopharyngoplasty on the nasality of voice.
        J Voice. 2004; 18: 423-430
        • Brosch S
        • Matthes C
        • Pirsig W
        • et al.
        Uvulopalatopharyngoplasty changes fundamental frequency of the voice: a prospective study.
        J Laryngol Otol. 2000; 114: 113-118
        • Mora R
        • Jankowska B
        • Crippa B
        • et al.
        Effects of uvulopalatopharyngoplasty with Harmonic Scalpel on speech and voice.
        Eur Arch Otorhinolaryngol. 2009; 266: 1989-1994
        • Akpinar ME
        • Kocak I
        • Gurpinar B
        • et al.
        Effects of soft palate implants on acoustic characteristics of voice and articulation.
        J Voice. 2011; 25: 381-386
        • Lewis J.R.
        • Andreassen M.L.
        • Leeper H.A.
        • et al.
        Thomas J. Vocal characteristics of children with cleft lip/palate and associated velopharyngeal incompetence.
        J Otolaryngol. 1993; 22: 113-117
        • Atan D
        • Özcan KM
        • Özcan M
        • et al.
        The effect of anterior palatoplasty plus modified expansion sphincter pharyngoplasty on voice performance in obstructive sleep apnea syndrome.
        J Craniofac Surg. 2017; 28 (PMID:28665845): e464-e467
        • Eun YG
        • Shin SY
        • Kim SW.
        Effects of uvulopalatopharyngoplasty with or without radiofrequency tongue base reduction on voice in patients with obstructive sleep apnea.
        Laryngoscope. 2013; 123 (Epub 2013 May 6. PMID:23649684): 1806-1810
        • Genta PR
        • Sands SA
        • Butler JP
        • et al.
        Airflow shape is associated with the pharyngeal structure causing OSA.
        Chest. 2017; 152: 537-546