Objective: Our purpose was to determine how anatomical conditions of the throat influence the degree and duration of posttonsillectomy transient hypernasality. Patients and Methods: A total of 82 tonsillectomies were performed. The participants were divided into groups: 1 - small tonsils, high soft palate position; 4 - large tonsils, low soft palate position, and 2 and 3 - intermediate tonsil dimensions and soft palate positions. Variables studied included the diameter of vapor (DV) on the mirror positioned under the patient's nose while articulating nasal sentences before and after surgery, the distance from the uvular tip to the posterior pharyngeal wall, healing grading as well as the degree and duration of hypernasality. Results: The mean hypernasality after tonsillectomy was greatest in group 4 and lowest in group 2. Before tonsillectomy, the mean DV was largest in group 2 and smallest in group 4. After tonsillectomy, the mean DV was largest in group 4 and smallest in group 3. Overall, the mean DV was significantly greater after tonsillectomy compared to the value before surgery. Conclusion: The degree of hypernasality after tonsillectomy depends on the soft palate position in relation to the tongue base and the size of the tonsils. Hypernasality is greatest in patients with large tonsils and a low soft palate position in relation to the tongue base. © 2014 S. Karger AG, Basel

Keywords:
Tonsillectomy, Hypernasality, Pharyngeal anatomy
1.
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.
2.
Kummer AW, Billmire DA, Myer CM 3rd: Hypertrophic tonsils: the effect on resonance and velopharyngeal closure. Plast Reconstr Surg 1993;91:608-611.
3.
Mora R, Jankowska B, Mora F, Crippa B, Dellepiane M, Salami A: Effects of tonsillectomy on speech and voice. J Voice 2009;23:614-618.
4.
Behrman A, Shikowitz MJ, Dailey S: The effect of upper airway surgery on voice. Otolaryngol Head Neck Surg 2002;127:36-42.
5.
Brosch S, Haase S: Open nasal speech and velopharyngeal insufficiency in adenoidectomy and tonsillectomy (in German). Laryngorhinootologie 2007;86:666-672, quiz 673-674.
6.
Roth JA, Pincock T, Sacks R, Forer M, Boustred N, Johnston W, Bailey M: Harmonic scalpel tonsillectomy versus monopolar diathermy tonsillectomy: a prospective study. Ear Nose Throat J 2008;87:346-349.
7.
Van Lierde KM, Wuyts FL, Bonte K, Van Cauwenberge P: The nasality severity index: an objective measure of hypernasality based on a multiparameter approach. A pilot study. Folia Phoniatr Logop 2007;59:31-38.
8.
Brancamp TU, Lewis KE, Watterson T: The relationship between nasalance scores and nasality ratings obtained with equal appearing interval and direct magnitude estimation scaling methods. Cleft Palate Craniofac J 2010;47:631-637.
9.
Finkelstein Y, Nachmani A, Ophir D: The functional role of the tonsils in speech. Arch Otolaryngol Head Neck Surg 1994;120:846-851.
10.
Haapanen ML, Ignatius J, Rihkanen H, Ertama L: Velopharyngeal insufficiency following palatine tonsillectomy. Eur Arch Otorhinolaryngol 1994;251:186-189.
11.
Wachtel JM, Kuehn DP, Weiss KS: Hypernasality after tonsillectomy without adenoidectomy in an adult. Otolaryngol Head Neck Surg 2000;122:112-113.
12.
Silva S, Ouda M, Mathanakumara S, Ridyard E, Morar P: Tonsillectomy under threat: auditing the indications for performing tonsillectomy. J Laryngol Otol 2012;126:609-611.
13.
Mattila PS, Tahkokallio O, Tarkkanen J, Pitkäniemi J, Karvonen M, Tuomilehto J: Causes of tonsillar disease and frequency of tonsillectomy operations. Arch Otolaryngol Head Neck Surg 2001;127:37-44.
14.
Kataura A, Tsubota H: Clinical analyses of focus tonsil and related diseases in Japan. Acta Otolaryngol Suppl 1996;523:161-164.
15.
Delanghe G, Ghyselen J, Feenstra L, van Steenberghe D: Experiences of a Belgian multidisciplinary breath odour clinic. Acta Otorhinolaryngol Belg 1997;51:43-48.
16.
Friedman M, Ibrahim H, Bass L: Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 2002;127:13-21.
17.
Brescovici S, Roithmann R: Modified Glatzel mirror test reproducibility in the evaluation of nasal patency. Braz J Otorhinolaryngol 2008;74:215-222.
18.
Bressmann T: Comparison of nasalance scores obtained with the Nasometer, the NasalView, and the OroNasal System. Cleft Palate Craniofac J 2005;42:423-433.
19.
Bettens K, Wuyts FL, De Graef C, Verhegge L, Van Lierde KM: Effects of age and gender in normal-speaking children on the Nasality Severity Index: an objective multiparametric approach to hypernasality. Folia Phoniatr Logop 2013;65:185-192.
20.
Zagólski O, Kulisiewicz J: Perioperative antibiotic in adenoidectomy with partial tonsillectomy: a randomized trial. ORL J Otorhinolaryngol Relat Spec 2012;74:86-92.
21.
Luyten A, D'haeseleer E, Hodges A, Galiwango G, Budolfsen T, Vermeersch H, Van Lierde K: Normative nasalance data in Ugandan English-speaking children. Folia Phoniatr Logop 2012;64:131-136.
22.
Rihkanen H, Soini I: Changes in voice characteristics after uvulopalatopharyngoplasty. Eur Arch Otorhinolaryngol 1992;249:322-324.
23.
Shprintzen RJ, Sher AE, Croft CB: Hypernasal speech caused by tonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1987;14:45-56.
24.
MacKenzie-Stepner K, Witzel MA, Stringer DA, Laskin R: Velopharyngeal insufficiency due to hypertrophic tonsils. A report of two cases. Int J Pediatr Otorhinolaryngol 1987;14:57-63.
25.
D'Antonio LL, Snyder LS, Samadani S: Tonsillectomy in children with or at risk for velopharyngeal insufficiency: effects on speech. Otolaryngol Head Neck Surg 1996;115:319-323.
26.
Saito T, Honda N, Saito H: Advantage and disadvantage of KTP-532 laser tonsillectomy compared with conventional method. Auris Nasus Larynx 1999;26:447-452.
© 2014 S. Karger AG, Basel
2014
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