Objective: To study voice changes in children after adenotonsillectomy or adenoidectomy and the relationship with the vocal tract structure. Methods: Fifty patients were recruited in this study prospectively, aged from 4 to 12 years old with the median age of 6. They were underwent adenotonsillectomy or adenoidectomy in Beijing Tongren Hospital, Capital Medical University from July 2019 to August 2020. In the cases, there are 31 males and 19 females. Thirty-six patients underwent adenotonsillectomy and 14 patients underwent adenoidectomy alone. Twenty-two children (13 males, 9 females) with Ⅰ degree of bilateral tonsils without adenoid hypertrophy and no snoring were selected as normal controls. Adenoid and tonsil sizes were evaluated. Subjective changes of voice were recorded after surgery. Moreover, voice data including fundamental frequency(F0), jitter, shimmer, noise to harmonic ratio(NHR), maximum phonation time(MPT), formant frequencies(F1-F5) and bandwidths(B1-B5) of vowel/a/and/i/were analyzed before, 3 days and 1 month after surgery respectively.SPSS 23.0 was used for statistical analysis. Results: Thirty-six patients(72.0%,36/50) complained of postoperative voice changes. The incidence was inversely correlated with age. In children aged 4-6, 7-9, and 10-12, the incidence was 83.3%(25/30), 63.6%(7/11) and 44.4%(4/9) respectively. Voice changes appeared more common in children underwent adenotonsillectomy(77.8%,28/36) than in those underwent adenoidectomy alone(57.1%,8/14), but there was no statistical difference. After operation, for vowel/a/, MPT(Z=2.18,P=0.041) and F2(t=2.13,P=0.040) increased, B2(Z=2.04,P=0.041) and B4(Z=2.00,P=0.046) decreased. For vowel/i/, F2(t=2.035,P=0.050) and F4(t=4.44,P=0.0001) increased, B2(Z=2.36,P=0.019) decreased. Other acoustic parameters were not significantly different from those before surgery. The F2(r=-0.392, P =0.032) of vowel/a/and F2(r=-0.279, P=0.048) and F4 (r=-0.401, P =0.028) of vowel/i/after adenotonsillectomy were significantly higher than those of adenoidectomy alone. Half of patients with postopertive voice changes can recover spontaneously 1 month after surgery. Conclusions: Voice changes in children underwent adenotonsillectomy or adenoidectomy might be related to their changes in formants and bandwidths. The effect of adenotonsillectomy on voice was more significant compared with that of adenoidectomy alone. The acoustic parameters did not change significantly after surgery except MPT.
目的： 探讨儿童腺样体及扁桃体切除术后发音特征变化，以及与声道结构的关系。 方法： 前瞻性纳入2019年7月至2020年8月在首都医科大学附属北京同仁医院行扁桃体及腺样体切除术或单纯腺样体切除术的患儿50例（男31例，女19例），年龄4~12岁，中位年龄6岁，其中同时行腺样体及扁桃体切除术者36例，单纯行腺样体切除术者14例。另选取双侧扁桃体Ⅰ度且无腺样体肥大，夜间睡眠无打鼾现象者22例（男13例，女9例）为对照组。评估腺样体及扁桃体大小，记录患儿手术后发音主观改变，分析术前、术后3 d、术后1个月平稳发/a/、/i/时的基频（F0）、频率微扰（jitter）、振幅微扰（shimmer）、噪谐比（NHR）、最长发音时间（MPT）、共振峰频率（formant frequencies，F1~F5）及带宽（bandwidths，B1~B5）变化。采用SPSS 23. 0软件进行统计学分析。 结果： 研究组中36例（72.0%）患儿诉术后出现发音改变，发生率与年龄呈负相关，其中4~6岁，7~9岁，10~12岁组患儿发生率分别为83.3%（25/30），63.6%（7/11），44.4%（4/9）。同时行腺样体及扁桃体切除术的患儿术后发音改变的发生率（77.8%，28/36）较单纯行腺样体切除术的患儿（57.1%，8/14）更高，但差异无统计学意义（P>0.05）。手术后患儿发元音/a/的MPT（Z=2.18，P=0.041）、F2（t=2.13，P=0.040）增高，B2（Z=2.04，P=0.041）、B4（Z=2.00，P=0.046）降低，元音/i/的F2（t=2.035，P=0.050）、F4（t=4.44，P=0.0001）增高，B2（Z=2.36，P=0.019）降低，其他各参数与术前无明显差异（P>0.05）。同时行腺样体及扁桃体切除术较单纯行腺样体切除术的患儿术后元音/a/的F2（r=-0.392，P=0.032）和元音/i/的F2（r=-0.279，P=0.048）、F4（r=-0.401，P=0.028）增高更为显著。50.0%患儿的发音改变在术后1个月自行恢复。 结论： 腺样体及扁桃体切除术引起患儿发音特征的变化与共振峰频率及带宽变化有关。同时行腺样体及扁桃体切除术对患儿发音特征的影响较单纯行腺样体切除术更为明显。除MPT外，手术前后嗓音声学参数变化不明显。.