# Abstract

 

## Objectives. The purpose is to investigate effect of septoplasty and widened nasal patency on voice quality. 

## Methods. Fifty patients who undergone septoplasty were included in the study. Thirty-three people who had similar age and distribution were enrolled as control group. Before and 1 and 3 months after surgery, anterior rhinomanometry, voice analysis by Multi-Dimensional Voice Program, and spectrographic analysis were performed to patients. The recordings of /a/ vowel were used to evaluate average fundamental frequency (F0), jitter percent, and shimmer percent. In spectrographic analyses, F3--F4 values for the vowels /i, e, a, o, and u/, nasal formant frequencies of the consonants /m/ and /n/ in the word /mini/, and 4 formant frequencies (F1, F2, F3, and F4) for nasalized /i/ vowel following a nasal consonant /n/ in the word /mini/ were compared. The differences in nasal resonance were evaluated. All patients were asked whether change in their voices after the surgery. Preoperative and postoperative voice parameters and anterior rhinomanometry results were compared separately with the control group as well as in the patient group itself. 

## Results. Preoperative total nasal resistance (TNR) values of patients were higher than the control group (*P*=0.001). TNR values of patients measured one day before surgery and after surgery in the 1st and 3rd months were different and these differences were significant statistically (*P*=0.001). There was no significant difference between the voice analysis parameters in preoperative, postoperative 1st, and 3rd months. As a result of their subjective reviews, 12 patients (36%) noted their voices were better than before surgery and 20 patients (61%) noted no change before and after surgery. 

## Conclusion. Providing widened nasal cavity has no effect on voice quality. # RESULTS There were 29 men and 21 women in the study group. None of them was applied sinus surgery. Seven patients who did not come to their postoperative controls, 3 patients who were observed septal perforation after septoplasty and could not be done ARM due to perforation, and 7 patients who had higher TNR value than avarage TNR value of control group were excluded. There were 9 patients applied radiofrequency ablation and all of them was in excluded group. Except absent patients, successful septoplasty rate was 77%. The study was conducted with 33 patients who have an increased nasal patency. Nineteen men (58%) and 14 women (42%) were enrolled as patient group and the mean age of patients was 25 years (range, 18 to 53 years). The mean age of control group was 27 years (range, 18 to 51 years) and there was no significant difference in terms of age and sex between patients and the control group (*P*\<0.05) ([Table 1](#)). Preoperative mean TNR value of patients was higher than the control group's and this difference was significant statistically (*P*=0.001). Preoperative TNR values of patients decreased post-operatively and these differences were again significant statistically (*P*=0.001) ([Table 2](#)). When asked patients whether changes in their voices after surgery, 20 patients (61%) noted no change, 12 patients (36%) said there was a change in a good way, and one (3%) noted a change in a bad way. Compared analysis results of /a/ vowel, there was no significant difference between the values before and 1 and 3 months after surgery ([Table 3](#)). Compared these results with the control group, there was no significant difference except NHR value (*P*=0.017). This difference was not reviewed, because it was not related to change of TNR. Compared analysis results of /n/ nasal consonant; there was no significant difference between the values before and 1 and 3 months after surgery. Compared these results with the control group, there were significant differences statistically about F3 formant freqency in postoperative 1st and 3rd months (*P*=0.022, *P*=0.024) and F4 formant frequency in postoperative 1st month (*P*=0.017) ([Table 4](#)). These differences were not significant clinically because these frequencies had not significant change in patient group. Compared analysis results of /mini/ word, there was no significant difference postoperative and with the control group ([Table 5](#)). ::::table-wrap

::: caption
Age and sex distrubition of study and control groups
:::

Characteristic Study group (n=33) Control group (n=30) *P*-value

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Age (yr) 25±10 27±6 0.442^[a)](#)^
Sex >0.999^[b)](#)^
Men 19 (58) 18 (60)\
Women 14 (42) 12 (40)

Values are presented as mean±SD or number (%).

Independent samples *t*-test.

Chi-square test.:::: ::::table-wrap
::: caption
Comparison of TNR values of study groups in their own and with control
group
:::

TNR Study group (n=33) Control group (n=30) *P*-value^[a)](#)^

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Preoperative 0.42 (0.32--0.76) 0.27 (0.23--0.34) 0.001
Postoperative 1st month 0.30 (0.23--0.35) - 0.420
Postoperative 3rd month 0.25 (0.23--0.26) - 0.018
*P*-value^[b)](#)^ 0.001 -

Values are presented as mean (interquartile range).

TNR, total nasal resistance.

Mann-Whitney *U*-test.

Friedman test in the repeated measures.:::: ::::table-wrap
::: caption
Comparison of /a/ vowel's voice analysis results of study group in their
own and with control group
:::

/a/ Study group (n=33) Control group (n=30) *P*-value^[a)](#)^

______________________________________________________________________

F0 (Hz)\
Preop 138 (125--225) 154 (124--207) 0.720
Postop 1st month 145 (113--220) - 0.847
Postop 3rd month 138 (117--220) - 0.739
*P*-value^[b)](#)^ for F0 0.282 -\
Jitter %\
Preop 0.62 (0.41--1.38) 0.85 (0.54--1.46) 0.645
Postop 1st month 1.17 (0.61--1.69) - 0.256
Postop 3rd month 1.33 (0.62--2.95) - 0.057
*P*-value^[b)](#)^ for jitter 0.343 -\
Shimmer %\
Preop 2.39 (1.94--2.91) 2.85 (2.09--4.40) 0.080
Postop 1st month 2.31 (1.98--4.20) - 0.375
Postop 3rd month 2.91 (1.80--3.98) - 0.422
*P*-value^[b)](#)^ for shimmer 0.871 -\
NHR\
Preop 0.12 (0.10--0.13) 0.13 (0.12--0.15) 0.017
Postop 1st month 0.12 (0.10--0.15) - 0.264
Postop 3rd month 0.14 (0.11--0.17) - 0.525
*P*-value^[b)](#)^ for NHR 0.051 -

Values are presented as mean (interquartile range).

F, frequency; Preop, preoperative; Postop, postoperative; NHR, noise to
harmonic ratio.

Mann-Whitney *U*-test.

Friedman test in the repeated measures.:::: ::::table-wrap
::: caption
Comparison of /n/ nasal consonant's voice analysis results of study
group in their own and with control group
:::

/n/ Study group (n=33) Control group (n=30) *P*-value^[a)](#)^

______________________________________________________________________

F3 (Hz)\
Preop 12,202 (10,022--13,489) 13,229 (11,188--14,145) 0.071
Postop 1st month 11,609 (9,381--13,467) - 0.022
Postop 3rd month 11,897 (9,869--13,193) - 0.024
*P*-value^[b)](#)^ for F3 0.485 -\
F4 (Hz)\
Preop 17,617 (15,657--18,613) 18,177 (17,178--18,698) 0.085
Postop 1st month 17,310 (15,586--18,349) - 0.017
Postop 3rd month 17,465 (16,020--18,311) - 0.084
*P*-value^[b)](#)^ for F4 0.639 -

Values are presented as mean (interquartile range).

F, frequency; Preop, preoperative; Postop, postoperative.

Mann-Whitney *U*-test.

Friedman test in the repeated measures.:::: ::::table-wrap
::: caption
Comparison of /mini/ word's voice analysis results of study group in
their own and with control group
:::

/mini/ Study group (n=33) Control group (n=30) *P*-value^[a)](#)^

______________________________________________________________________

F1 (Hz)\
Preop 322 (283--368) 332 (298--387) 0.591
Postop 1st month 327 (292--371) - 0.762
Postop 3rd month 322 (283--379) - 0.773
*P*-value^[b)](#)^ for F1 0.279 -\
F2 (Hz)\
Preop 2,292 (2,056--2,384) 2,166 (2,086--2,333) 0.500
Postop 1st month 2,287 (2,003--2,390) - 0.967
Postop 3rd month 2,243 (2,077--2,485) - 0.413
*P*-value^[b)](#)^ for F2 0.871 -\
F3 (Hz)\
Preop 3,150 (2,989--3,257) 3,038 (2,899--3,255) 0.277
Postop 1st month 3,057 (2,946--3,212) - 0.752
Postop 3rd month 3,081 (2,931--3,373) - 0.387
*P*-value^[b)](#)^ for F3 0.245 -\
F4 (Hz)\
Preop 4,008 (3,744--4,261) 3,853 (3,674--4,236) 0.335
Postop 1st month 3,913 (3,543--4,188) - 0.880
Postop 3rd month 3,915 (3,654--4,312) - 0.617
*P*-value^[b)](#)^ for F4 0.871 -

Values are presented as mean (interquartile range).

F, frequency; Preop, preoperative; Postop, postoperative.

Mann-Whitney *U*-test.

Friedman test in the repeated measures.::::


Extracted trial result:
Outcome: "n" consonant improvement (continuous)
Intervention: Septoplasty
Comparator: Control
Intervention group size: 33
Intervention mean: 11897
Comparator group size: 30
Comparator mean: 13229
Notes: Used F0 (Hz) values. SD is not given.