Improved Voice Quality, Satisfaction Linked to Endoscopic Sinus Surgery


This new study, which followed patients up to 6 months after functional endoscopic sinus surgery, evaluated results using objective and subjective measures.

Improved voice quality and patient satisfaction with their voice were seen following functional endoscopic sinus surgery (FESS) for nasal polyposis among a cohort of 46 patients who underwent the procedure between August 1, 2015, and August 1, 2017, according to new study findings published in Scientific Reports.

“Nasal polyps are associated with hyponasality,” the study investigators wrote. “The effect of FESS on voice quality has not been adequately investigated; therefore, this study developed objective and subjective measurements to compare nasal polyp patients pre- and post surgery.”

All of the patients included in this analysis were evaluated for nasal polyp grade, nasometry, acoustic parameters, acoustic perception, and patient satisfaction at 4 time points (before surgery and 1-, 3-, and 6-month marks after surgery). Their mean (SD) age was 48.2 (16.2) years, and 63.0% were identified as male patients. All also underwent nasal endoscopy and a laryngoscopic exam before FESS. Nasometer II: Model 6450 was used to gauge nasal resonance, a computerized speech lab considered acoustic parameters, the GIRBAS (grading, instability, roughness, breathiness, asthenia, and strain) scale was instrumental in subjectively measuring voice perception, and a standard set of words and sentences was used to measure hyponasality and hypernasality. Patient voice quality satisfaction was rated on a visual analogue scale (VAS) of 0 (very dissatisfied) to 10 (extreme satisfaction).

Seventy-six percent of patients presented with grade 2/3 right-side nasal polyps and 80.5%, grade 2/3 left-side nasal polyps. Nine patients were lost to follow-up, but among the remaining study population, most patients had more-than-4 mm–enlarged maxillary ostium and sphenoid sinus.

Nasometry results indicated significantly increased mean scores among all patients after surgery (P < .05), but no differences were seen for acoustic parameters at the 3 follow-up periods (P > .05). Normal nasality also significantly improved among the 50% of patients who were indicated to be hyponasal at baseline (before surgery) (P < .001), while the GIRBAS scale “showed no significant acoustic perceptual difference between the pre- and postoperative periods (P > .05),” the study authors wrote.

The most common identified underlying disease among the patients was “other” in 32.6%, followed by hypertension in 15.2%, allergy in 13.0%, and diabetes in 2.2%. Forty-six percent reported no underlying disease. Mean Lund-Mackay scores were equivalent for the left and right nasal cavities of the patients: 8.0 (3.0) and 8.2 (3.0), respectively.

After FESS, nasal polyposis characteristics were evaluated for the maxillary sinus, ethmoid sinus, frontal sinus, and sphenoid sinus. By the 6-month mark, residual/recurrent nasal polyps were not seen among most patients’ ethmoid, maxillary, or sphenoid sinus.

Overall, VAS scores showed consistent improvements across all patient follow-up appointments. At the 1-month follow-up, the mean score was 8.0 (1.4); at the 3-month follow-up, 8.5 (1.5); and at the 6-month follow-up, 8.7 (1.3) (P < .05).

The authors highlighted that their findings could be useful among individuals who use their voices in a professional manner.

“Endoscopic surgical treatment in nasal polyposis patients allowed significantly increased nasometry with better acoustic perception,” they concluded. “Furthermore, the insignificantly changing acoustic parameters showed that surgery did not significantly disturb the voice at the glottic level.”


Naruekon J, Kasemsiri P, Thanaviratananich S, Prathanee B, Thongrong C, Reechaipichitkul. Voice quality changes after functional endoscopic sinus surgery in patients with nasal polyps. Sci Rep. Published online December 8, 2022. doi:10.1038/s41598-022-25841-8

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