Yang J J, Cheng L Y, Xu W
Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2021 Jul 7;56(7):724-729. doi: 10.3760/cma.j.cn115330-20200813-00672.
To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. Moreover, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(=2.18,=0.041) and F2(=2.13,=0.040) increased, B2(=2.04,=0.041) and B4(=2.00,=0.046) decreased. For vowel/i/, F2(=2.035,=0.050) and F4(=4.44,=0.0001) increased, B2(=2.36,=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(=-0.392, =0.032) of vowel/a/and F2(=-0.279, =0.048) and F4 (=-0.401, =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT.
研究腺样体扁桃体切除术或腺样体切除术后儿童的嗓音变化及其与声道结构的关系。本研究前瞻性招募了50例患者，年龄4至12岁，中位年龄6岁。他们于2019年7月至2020年8月在首都医科大学附属北京同仁医院接受了腺样体扁桃体切除术或腺样体切除术。其中，男性31例，女性19例。36例患者接受了腺样体扁桃体切除术，14例患者仅接受了腺样体切除术。选取22例双侧扁桃体Ⅰ度、无腺样体肥大且无打鼾的儿童（男13例，女9例）作为正常对照。评估腺样体和扁桃体大小。记录术后嗓音的主观变化。此外，分别在术前、术后3天和1个月分析嗓音数据，包括基频（F0）、抖动、闪烁、噪声谐波比（NHR）、最长发声时间（MPT）、元音/a/和/i/的共振峰频率（F1 - F5）及带宽（B1 - B5）。采用SPSS 23.0进行统计分析。36例患者（72.0%，36/50）主诉术后嗓音有变化。发病率与年龄呈负相关。4至6岁、7至9岁和10至12岁儿童的发病率分别为83.3%（25/30）、63.6%（7/11）和44.4%（4/9）。接受腺样体扁桃体切除术的儿童（77.8%，28/36）嗓音变化比仅接受腺样体切除术的儿童（57.1%，8/14）更常见，但差异无统计学意义。术后，对于元音/a/，MPT（=2.18，=0.041）和F2（=2.13，=0.040）升高，B2（=2.04，=0.041）和B4（=2.00，=0.046）降低。对于元音/i/，F2（=2.035，=0.050）和F4（=4.44，=0.0001）升高，B2（=2.36，=0.019）降低。其他声学参数与术前无显著差异。腺样体扁桃体切除术后元音/a/的F2（=-0.392，=0.032）以及元音/i/的F2（=-0.279，=0.048）和F4（=-0.401，=0.028）显著高于仅行腺样体切除术者。术后嗓音有变化的患者中有一半在术后1个月可自行恢复。接受腺样体扁桃体切除术或腺样体切除术的儿童嗓音变化可能与其共振峰和带宽的变化有关。与仅行腺样体切除术相比，腺样体扁桃体切除术对嗓音的影响更显著。除MPT外，术后声学参数无明显变化。
