Nasal resonance changes after endoscopic endonasal transsphenoidal skull base surgery: Analysis of voice quality

Pornthep Kasemsiri, Pichayen Duangthongphon, Benjamas Prathanee, Cattleya Thongrong, Pornthep Kasemsiri, Pichayen Duangthongphon, Benjamas Prathanee, Cattleya Thongrong

Abstract

Objectives: To study the effect of endoscopic endonasal transsphenoidal surgery on voice quality in patients with pituitary lesions.

Methods: An observational study comparing voice quality before and after surgery was conducted between September 2015 and September 2017 at Srinagarind Hospital, Khon Kaen University, Thailand. Pituitary tumor patients who underwent endoscopic endonasal transsphenoidal surgery were recruited. The nasal corridors were created with a type I (preserving both middle turbinates with a rescue flap) or type II (cutting one middle turbinate with a raised nasoseptal flap) for the binostril with four-hand technique. All patients were evaluated for nasal resonance, acoustic parameters, acoustic perception, and self-assessment of their satisfaction with postoperative voice changes with a visual analog scale (VAS). The patients were evaluated 1 day before surgery and at 1 and 3 months after surgery.

Results: Forty-four patients, including 19 males and 25 females with a mean age of 50.0 ± 15.6 years, were enrolled. Mean scores for nasal resonance and all acoustic parameters were not significantly changed after surgery for either nasal corridor type (p > .05). Regarding acoustic perception, word and sentence and GIRBAS scores showed no significant difference before and after surgery (p > .09) in either type of nasal corridor. There was no incidence of hypernasality voice after surgery. Patients' self-satisfaction ratings (i.e., VAS) with voice quality were high and showed no significant change 1 and 3 months postsurgery (p > .05).

Conclusions: These endoscopic endonasal transsphenoidal approaches are minimally invasive skull base surgery techniques that have minimal effects on postsurgery voice quality.

Trial registration: This trial was registered at ClinicalTrial.gov (NCT02828514).

Level of evidence: 4.

Keywords: endoscopic; nasal resonance; pituitary; transsphenoidal surgery; voice.

Conflict of interest statement

All authors have no personal financial or institutional interest in any of the materials and devices described in this article. The authors have no conflicts of interest to declare.

© 2021 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.

Figures

FIGURE 1
FIGURE 1
Nasal corridor type I was created with a rescue flap. Both middle turbinates were preserved. The posterosuperior portion of the bony septum was resected, whereas the septal mucosa was preserved and displaced inferiorly (A). The nasal endoscopic findings showed mucosal recovery following surgery at 3 months (B). Abbreviations: Lt, left; MT, middle turbinate; RF, rescue flap; Rt, right; SR, sellar region; SS, sphenoid sinus
FIGURE 2
FIGURE 2
Nasal corridor type II was created with a nasoseptal flap. The middle turbinate was cut, and the nasoseptal flap was raised for reconstruction at the surgical defect. Posterior septectomy was performed to create the common cavity (A). The nasal endoscopic findings showed mucosal recovery and nasoseptal healing after surgery at 3 months (B). Abbreviations: IT, inferior turbinate; Lt, left; MT, middle turbinate; NSF, nasoseptal flap; NSF, nasoseptal flap; SR, sellar region

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