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We noticed a statistically significant difference in data We didn’t include open procedures because our target
derived from the answers 6 months after surgery (P was an evaluation after a single and standardized
= 0.047). Patients noticed effects on voice not only in surgery. Objective and subjective analyses supported this
general, but also for every single area of questions. The evaluation, the first one performed with a spectrographic
increased score suggests that vocal features significantly study of vocal sounds frequencies (data expressed in
change after closed rhinoplasty. Hertz) before and 6 months after surgery, the second one
supported by the Italian version of the “Voice Handicap
The objective evaluation was conducted with a Index Score”.
spectrographic analysis for the 4 sounds (“A”/“E” vowels,
“N” and “M” consonants), before and 6 months after The objective study, performed with an open source
surgery. The frequency of every single spectrogram software and a professional recording system, helped us
(Hz) was the main considered parameter. We have to to notice effective changes on intensity and frequency
underline that data extracted from the spectrographic of voice after surgery. This evaluation was performed
analysis of vowel sounds clearly show the improved vocal again after 6 months. The Mann-Whitney test allowed us
pattern in patients undergoing closed rhinoplasty. We to analyze data. An example of a spectrogram from our
found an increased frequency of emission of consonant study is shown on Figure 2.
sounds in 69% of cases (P = 0.046), and in 74% of cases
for vowels (P = 0.048). The results of this analysis are Data extracted from the spectrographic analysis let us
shown in Figure 1. We didn’t detect major complications discover a statistically significant change of the frequency
in the immediate postoperative period (2 weeks). emission for the “A” and “E” vowels and the “N”/“M”
consonants (results with data expressed in Hertz are
DISCUSSION summarized on Figure 1).

The subjective evaluation showed significant changes
Changes on voice after closed rhinoplasty were the main
target of this preliminary report: we found statistically about the perception of voice after this kind of surgery (P
= 0.047). This evaluation helped us to study the impact
significant effects on several vocal features.
of these changes on the professional and everyday life
of the 19 subjects. This result, although it represents the
In literature, we didn’t find any work about the impact of first and preliminary step of our evaluation, is statistically
exclusively closed rhinoplasty on individual and technical
features of voice. [9-12] This preliminary evaluation begins significant.
from the principle that changes in nasal cavity volume In our opinion, these changes could be caused by the lateral
may bring effects to the resonance system and frequency low-to-high osteotomies performed during the surgery.
of several vocal sounds. [13-16]
Several characteristics of vocal pattern, according to our
We conducted a preliminary report and enrolled 19 preliminary evaluation, can be statistically changed by this
patients which underwent a closed primary rhinoplasty. kind of surgery. The subjective analysis reveals how surgery
can change the personal and ideal perception of voice.
The objective evaluation helped us to notice differences
in sound frequency and amplitude after surgery. Bringing
the focus of our study to everyday life, we can say that
every surgeon who performs a closed rhinoplasty should
accurately talk to patients about potential changes on
the quality of voice, first of all through the informed
consent. Limitations of our study were the small series of
patients and the relatively short period of evaluation. We
will evaluate more patients for a longer period of time, in
order to confirm the results of our preliminary report.

Financial support and sponsorship
Nil.

Conflicts of interest
There are no conflicts of interest.

REFERENCES

Figure 2: An example of a spectrogram analyzed in our preliminary report 1. Brandt MG, Rotenberg BW, Moore CC, Bornbaum CC, Dzioba A,
Plast Aesthet Res || Volume 3 || July 7, 2016 233