Analysis of Nasalance in Patients with Chronic Rhinosinusitis

Sung-Jae Park; Ji-Su Park; Jun Xu; Youngae Kang; Yong Min Kim; Ki-Sang Rha

doi:10.18787/jr.2016.23.1.31

Journal List > J Rhinol > v.23(1) > 1044361

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Park, Park, Xu, Kang, Kim, and Rha: Analysis of Nasalance in Patients with Chronic Rhinosinusitis

Original Article

J Rhinol 2016;23(1):31-38.

Published online: 10 January 2016

DOI: https://doi.org/10.18787/jr.2016.23.1.31

Analysis of Nasalance in Patients with Chronic Rhinosinusitis

Sung-Jae Park, MD, Ji-Su Park, MD, Jun Xu, MD, Youngae Kang, PhD, Yong Min Kim, MD, PhD, Ki-Sang Rha, MD, PhD

Department of Otorhinolaryngology, School of Medicine, Chungnam National University, Daejeon, Korea

교신저자：나기상, 35015 대전광역시 중구 문화로 282 충남대학교 의학전문대학원 이비인후과학교실 Tel: +82-42-280-7698, Fax: +82-42-253-4059, E-mail: ksrha@cnu.ac.kr

Received 14 October 2015 Revised 23 November 2015 Accepted 28 December 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background and Objectives

This study was designed to compare the nasalance between chronic rhinosinusitis (CRS) patients and normal controls and to determine the correlation of nasalance with nasal volume, nasal resistance, CT score, and polyp score in CRS patients.

Materials and Methods

This study enrolled 150 CRS patients and 154 normal adults. All subjects underwent acoustic rhinometry and rhinomanometry. Nasalance scores were measured with the nasometer. All CRS patients were graded according to the Lund-Mackay CT staging system and the degree of nasal polyp.

Results

Nasal volume was decreased and nasal resistance was increased in CRS patients compared with normal controls. However, the nasalance scores for oro-nasal and nasal passages were significantly higher in CRS patients compared with normal controls. In CRS patients, the nasalance score for the nasal passage showed positive correlation with nasal volume and negative correlation with nasal resistance and Lund-Mackay CT score. However, no significant correlation was found between nasalance score and endoscopic polyp score.

Conclusion

Contrary to expectations, nasalance was increased in CRS patients despite decreased nasal volume and increased nasal resistance. Thus, nasal resonance likely depends on a multitude of factors other than changes in the sinonasal cavity.

Keywords: Sinusitis, Nasal polyps, Voice quality, Nasal cavity.

References

1). 김익태, 민양기, 양경헌. 비강 및 부비동의 생리. 민양기. 임상비과학. 1st ed.Seoul: 일조각;1997. p. 41–62.

2). Hosemann W, Göde U, Dunker JE, Eysholdt U. Influence of endoscopic sinus surgery on voice quality. Eur Arch Otorhinolaryngol. 1998; 255:499–503.

3). Gerek M, Durmaz A, Aydin U, Birkent H, Hidir Y, Tosun F. Relationship between nasal valve changes and nasalance of the voice. Otolaryngol Head Neck Surg. 2012; 147:98–101.

4). Williams RG, Eccles R, Hutchings H. The relationship between nasalance and nasal resistance to airflow. Acta Otolaryngol. 1990; 110:443–9.

5). Mora R, Jankowska B, Dellepiane M, Mora F, Crippa B, Salami A. Acoustic features of voice after septoplasty. Med Sci Monit. 2009; 15:CR269–73.

6). Havel M, Ertl L, Bauer D, Schuster M, Stelter K, Sundberg J. Res-onator properties of paranasal sinuses: preliminary results of an anatomical study. Rhinology. 2014; 52:178–82.

7). Soneghet R, Santos RP, Behlau M, Habermann W, Friedrich G, Stammberger H. Nasalance changes after functional endoscopic sinus surgery. J Voice. 2002; 16:392–7.

8). Dhong HJ, Kim SI, Kwon JK, Yun YS, Kang SM, Chu KC. Effects of endoscopic sinus surgery on nasality. Korean J Otolaryngol. 1999; 42:871–5.

9). Hong KH, Kwon SH, Jung SS. The assessment of nasality with a nasometer and sound spectrography in patients with nasal polyposis. Otolaryngol Head Neck Surg. 1997; 117:343–8.

10). Chen MY, Metson R. Effects of sinus surgery on speech. Arch Otolaryngol Head Neck Surg. 1997; 1213:845–52.

11). Jiang RS, Huang HT. Changes in nasal resonance after functional endoscopic sinus surgery. Am J Rhinol. 2006; 20:432–7.

12). Kim SD, Park HJ, Kim GH, Wang SG, Roh HJ, Cho KS. Changes and recovery of voice quality after sinonasal surgery. Eur Arch Otorhinolaryngol. 2015; 272:2853–9.

13). Kim YH, Lee SH, Park CW, Cho JH. Nasalance change after sinonasal surgery: analysis of voice after septoturbinoplasty and endoscopic sinus surgery. Am J Rhinol Allergy. 2013; 27:67–70.

14). Dalston RM. Acoustic assessment of the nasal airway. Cleft Palate Craniofac J. 1992; 29:520–6.

15). Park MK, Lee EK, Yu SC, Koh KS, Kim BJ, Baek RM. Nasalance scores in normal Koreans. 65th American Cleft Palate-Craniofacial Association Annual Meetings. 2008 April 14. -18; Philadelphia, PA, USA.

16). Park M, Baek WS, Lee EK, Koh KS, Kim BK, Baek RM. Nasalance scores for normal Korean-speaking adults and children. J Plast Reconstr Aesthet Surg. 2014; 67:173–7.

17). Birkent H, Erol U, Ciyiltepe M, Eadie TL, Durmaz A, Tosun F. Relationship between nasal cavity volume changes and nasalance. J Laryngol Otol. 2009; 123:407–11.

18). Pegoraro-Krook MI, Dutka-Souza JCR, Williams WN, Teles Magal-haes LC, Rossetto PC, Riski JE. Effect of nasal decongestion on nasalance measures. Cleft Palate Craniofac J. 2006; 43:289–94.

19). Lund VJ, MacKay IS. Staging in rhinosinusitis. Rhinology. 1993; 31:183–4.

20). Johansen LV, Illum P, Kristensen S, Winther L, Petersen SV, Synner-stad B. The effect of budesonide (Rhinocort) in the treatment of small and medium-sized nasal polyps. Clin Otolaryngol. 1993; 18:524–7.

21). Abou-Elsaad T, Quriba A, Baz H, Elkassaby R. Standardization of nasometry for normal Egyptian Arabic speakers. Folia Phoniatr Logop. 2012; 64:271–7.

22). Awan SN, Bressmann T, Poburka B, Roy N, Sharp H, Watts C. Di-alectical effects on nasalance: a multicenter, cross-continental study. J Speech Lang Hear Res. 2015; 58:69–77.

23). Kim CS, Kong SK, Lee HS, Cho KS, Wang SG, Roh HJ. Analysis of changes in nasal formant, spectra and resonant volume in rhino-sinus after endoscopic sinus surgery. Korean J Otolaryngol. 2000; 43:1208–15.

Fig. 1.

Correlation between the total nasal cavity volume and the nasalance score for three passages in patients with chronic rhinosinusitis. A: Oral passage. B: Oro-nasal passage. C: Nasal passage.

Fig. 2.

Correlation between the expiratory total nasal resistance and the nasalance score for three passages in patients with chronic rhinosinusitis. A: oral passage. B: Oro-nasal passage. C: Nasal passage.

Fig. 3.

Correlation between the CT score and the nasalance score for three passages in patients with chronic rhinosinusitis. A: Oral passage. B: Oro-nasal passage. C: Nasal passage.

Fig. 4.

Correlation between the endoscopic polyp score and the nasalance score in patients with chronic rhinosinusitis. A: Oral passage. B: Oro-nasal passage. C: Nasal passage.

Fig. 5.

Comparison of the nasalance score between normal controls and patient groups classified according to the Lund-Mackay CT score. A: Oral passage. B: Oro-nasal passage. C: nasal passage. The lower and upper limits of the boxes represent the 25th and 75th percentiles, respectively. Horizontal bars represent the median values; whiskers represent the range. *: p＜0.05, **: p＜0.01, ***: p＜0.001.

Fig. 6.

Comparison of the nasalance score between normal controls and patient groups classified according to the endoscopic polyp score. A: oral passage. B: oro-nasal passage. C: nasal passage. The lower and upper limits of the boxes represent the 25th and 75th percentiles, respectively. Horizontal bars represent the median values; whiskers represent the range. *: p＜0.05, ***: p ＜0.001.

Table 1.

Korean passages used in nasometric test

Oral passage	수희 가족이 바다에 갔다. 배도 타고 튜브도 탔다. 갑자기 비가 와서 집으로 돌아왔다.
Devoid of nasal consonant, 33 syllables	Suhi kaɟogi padae katt’a. pɛdo tʰago tʰjubɨdo tʰatt’a. kapɟagi piga wasə cibɨro tolawatt’a
Oro-nasal passage	오늘은 대공원에 소풍 가는 날이다. 엄마가 김밥도 만드셨다. 과자랑 스케치북이랑 가져갔다.
32.6% nasal consonant, 37 syllables	Onɨlɨn tɛgoŋwəne sopʰuŋ kanɨn nalida. əmmaga kimbapt’o mandɨʃjətt’a. kwaɟaraŋ sɨkʰecʰibugiraŋ kaɟjəgatt’a
Nasal passage	엄마안녕 엄마안녕, 매미안녕 매미안녕, 나무안녕 나무안녕
Devoid of oral consonant, 24 syllables	Əmma annjəŋ əmma annjəŋ. mɛmi annjəŋ mɛmi annjəŋ. namu annjəŋ namu annjəŋ

Table 2.

Comparison of the mean values of nasal cavity volume, total nasal resistance and nasalance score between CRS patients group and normal controls

	Control group (n=154)	CRS group (n=150)
Age	45.02 (21–70)	47.06 (20–79)
Sex (male/female)	101/53	101/49
Total nasal cavity volume (cm³)	26.80±6.71	20.92±6.51^*
Total nasal resistance (Pa/cm³/sec)
Inspiratory	00.29±0.20	00.81±0.72^*
Expiratory	00.30±0.20	00.99±0.84^*
Nasalance score (%)
Oral passage	13.68±4.28	14.70±6.36^*
Oro-nasal passage	36.07±7.08	40.54±7.69^*
Nasal passage	60.98±7.11	65.25±7.73^*

^* : p＜0.001

TOOLS

Similar articles