| Objective:Uvulopalatopharyngoplasty (UPPP) is a commonly used surgical technique for oropharygeal reconstruction in patients with obstructive sleep spnea hypopnea syndrome(OSAHS). UPPP modify the anatomical structure of the upper airways and the resonance characteristics of the vocal tract. This may lead to a modification in voice quality. Because the surgical procedure of UPPP does not involve laryngeal tissue, it was hypothesized that the voice characteristics remain relatively stable. And it was hypothesized that formants and nasalance would change from the pre-surgery to the post-surgery condition because the surgical protocol involves removal of palatal tissue and effective velar length. However very few objective investigations had been carried out. This study explored the impact of changes in the pharynx on vocal function and resonance function to evaluate the effect of UPPP on voice and in order to provide a reference for the selection of UPPP surgery population.Methods:The study included30male adult patients with a mean age of44.7years. All patients were diagnosed with OSAHS based on polysomnography (PSG) examination. The30male adult patients who underwent surgery for UPPP were recorded pre-surgery,1-week post-surgery and3-month post-surgery speech.And then in this study, the average fundamental frequency (F0), Jitter, Shimmer, and noise-to-harmonic ratio (NHR) of the long vowel/a/were measured acoustically by the multi-dimensional voice program (MDVP) to evaluate the vocal functionobjectively.The first second formant frequencies (F1, F2) of three long vowels/a/,/i/and/u/were determined by linear prediction coding (LPC) to evaluate the oral resonance function objectively.The Nasometer Ⅱ (model6450) was used to obtain nasalance scores of the oral sentence, the oranasal sentence, and the nasal sentence to evaluate the nasal resonance function objectively. And then all the data were statistically analyzed by spssl7.0.Result: 1. FO, Jitter, Shimmer, and NHR were unchanged from the pre-surgery to the post-surgery condition.2. One week after the surgery, the first second formant frequencies (F1, F2) of three long vowels/a/,/i/and/u/were remained essentially unchanged (P>0.05).Three months after surgery, the first second formant frequencies (F1, F2) of the vowel/a/and F1of the vowel/u/were remained essentially unchanged (P>0.05); while the frequency of F1, F2of the vowel/a/and of F2of the vowel/u/were significantly higher compared to pre-surgery values (P<0.05).3. One week after the surgery, the nasalance scores of the oral sentence, the oranasal sentence, and the nasal sentence were remained essentially unchanged (P>0.05).Three months after surgery, the nasalance scores of the oral sentence and the oranasal sentence were remained essentially unchanged (P>0.05); while the nasalance scores of the nasal sentence were significantly higher compared to pre-surgery values (P<0.05).The findings of this study indicate that UPPP did not have a significant impact on the vocal function. But it might have a certain effect on resonance function.Conclusion:1. UPPP lifted the upper airway obstruction in adult patients with OSAHS through the shaping of pharyngeal. Because the surgical procedure did not involve laryngeal tissue and intervene in the vocal cords, it did not affect the function of the larynx and vocal cords. That was to say that UPPP did not have a significant impact on the vocal function. But the modifications in the anatomical structure and volume of the vocal tract, induced by the surgical procedures used for the treatment of OSAHS, might have a certain effect on resonance function, demonstrated by the change of several formant frequency and nasalance.2. Singer, drama, radio host and all professional voice users have a higher requirement of resonance, and need more accurate pronunciation than ordinary person. Therefore UPPP in such patients should be cautiously. And such patients who want to undergo UPPP must be informed of this potential modification of the voice. |
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