鼻部手术会改变嗓音共鸣吗？鼻整形术、鼻中隔成形术和鼻甲成形术的声学影响——一项系统综述和荟萃分析。

文献信息

中文摘要

背景： 鼻部手术，包括鼻整形术、鼻中隔成形术和鼻甲成形术，是全球最常进行的耳鼻喉科手术之一，每年进行数百万例。鼻腔作为声道中的关键共鸣器，通过复杂的声学耦合机制对嗓音质量做出贡献。鼻部解剖结构的改变理论上可能改变嗓音共鸣特征，但不同手术方式之间的临床意义和比较效果仍不完全清楚。本系统综述旨在综合当前关于鼻整形术、鼻中隔成形术和鼻甲成形术后声学嗓音变化的证据，比较不同手术类型之间变化的幅度和临床相关性。
方法： 遵循PRISMA 2020指南，我们在六个数据库（PubMed MEDLINE、EMBASE、Scopus、Web of Science核心合集、Cochrane CENTRAL和Google Scholar）中进行了全面的系统检索，截至2023年12月。符合条件的研究包括前瞻性或回顾性研究，测量成年患者鼻部手术前后的客观声学参数（鼻音度、共振峰频率、基频、嗓音质量指数）或主观嗓音结果。研究按手术类型分层。质量评估采用修改后的纽卡斯尔-渥太华量表标准用于观察性研究。在数据同质性足够的情况下，对鼻中隔成形术的鼻音度结果进行了随机效应荟萃分析。应用GRADE框架评估证据确定性。
结果： 从832条初始记录中，676项独特研究进行了标题/摘要筛选，189篇全文文章评估了资格。43项研究符合纳入标准（鼻中隔成形术：n=26，鼻整形术：n=11，鼻甲成形术：n=5，联合手术：n=1），涵盖2,039名患者。对12项鼻中隔成形术研究（N=600名患者）的荟萃分析显示，鼻音音素的鼻音度评分汇总平均增加17.2个百分点（95% CI：15.0-19.4，p<0.001），存在显著异质性（I²=66.1%）。亚组分析显示前瞻性（n=11项研究，18.6个百分点，95% CI：14.8-22.4）和回顾性（n=1项研究，11.2个百分点，95% CI：8.4-14.0）研究设计的效果一致。鼻整形术研究（n=399名患者）显示对共振峰频率F3-F5的影响不一，专业嗓音使用者对声学变化表现出更高的敏感性。鼻甲成形术研究（n=224名患者）显示中等效果。质量评估确定27项高质量研究（63%），16项中等质量（37%），0项低质量（0%）。GRADE评估表明鼻中隔成形术鼻音度结果的确定性极低，鼻整形术和鼻甲成形术结果的确定性低。漏斗图分析和Egger回归检验（t=1.34，df=10，p=0.21）表明漏斗图不对称性无统计学显著性。剪补分析插入了零项研究，汇总估计值保持不变；鉴于研究数量少且异质性大，这些分析应谨慎解读。
结论： 现有的观察性证据表明，鼻部手术可能与嗓音共鸣的可测量改变有关。鼻中隔成形术与鼻音度增加相关（汇总增加17.2个百分点，95% CI：15.0-19.4），而鼻整形术研究报告了较高共振峰频率的可变变化，鼻甲成形术研究报告了中等的声学效果。这些变化的临床意义仍不确定，有限的观察性证据表明，专业嗓音使用者可能对细微的声学改变更敏感。术前咨询应涉及潜在的嗓音变化，特别是对于高嗓音需求的人群。未来的研究应采用标准化的声学方案和更长的随访期，以更好地描述恢复轨迹并识别有临床显著嗓音改变风险的患者亚组。

英文摘要

BACKGROUND: Nasal surgeries including rhinoplasty, septoplasty, and turbinoplasty are among the most commonly performed otolaryngologic procedures worldwide, with millions of operations conducted annually. The nasal cavity functions as a critical resonator in the vocal tract, contributing to voice quality through complex acoustic coupling mechanisms. Alterations in nasal anatomy may theoretically modify vocal resonance characteristics, yet the clinical significance and comparative effects across different surgical procedures remain incompletely understood. This systematic review aimed to synthesize current evidence on acoustic voice changes following rhinoplasty, septoplasty, and turbinoplasty, comparing the magnitude and clinical relevance of alterations across procedure types.
METHODS: Following PRISMA 2020 guidelines, we conducted a comprehensive systematic search across six databases (PubMed MEDLINE, EMBASE, Scopus, Web of Science Core Collection, Cochrane CENTRAL, and Google Scholar) through December 2023. Eligible studies included prospective or retrospective investigations measuring objective acoustic parameters (nasalance, formant frequencies, fundamental frequency, voice quality indices) or subjective voice outcomes before and after nasal surgery in adult patients. Studies were stratified by surgical procedure type. Quality assessment employed modified Newcastle-Ottawa Scale criteria for observational studies. Random-effects meta-analysis was performed for septoplasty nasalance outcomes where sufficient data homogeneity existed. GRADE framework was applied to assess certainty of evidence.
RESULTS: From 832 initial records, 676 unique studies underwent title/abstract screening, with 189 full-text articles assessed for eligibility. Forty-three studies met inclusion criteria (septoplasty: n=26, rhinoplasty: n=11, turbinoplasty: n=5, combined procedures: n=1), encompassing 2,039 patients. Meta-analysis of 12 septoplasty studies (N=600 patients) demonstrated a pooled mean increase in nasalance scores for nasal phonemes of 17.2 percentage points (95% CI: 15.0-19.4, p<0.001) with substantial heterogeneity (I²=66.1%). Subgroup analysis showed consistent effects across prospective (n=11 studies, 18.6 pp, 95% CI: 14.8-22.4) and retrospective (n=1 study, 11.2 pp, 95% CI: 8.4-14.0) study designs. Rhinoplasty investigations (n=399 patients) showed variable effects on formant frequencies F3-F5, with professional voice users exhibiting greater sensitivity to acoustic changes. Turbinoplasty studies (n=224 patients) revealed intermediate effects. Quality assessment identified 27 high-quality studies (63%), 16 moderate-quality (37%), and 0 low-quality (0%). GRADE assessment indicated very low certainty for septoplasty nasalance outcomes and low certainty for rhinoplasty and turbinoplasty outcomes. Funnel plot analysis and Egger's regression test (t=1.34, df=10, p=0.21) indicated no statistically significant funnel plot asymmetry. Trim-and-fill analysis imputed zero studies, leaving the pooled estimate unchanged; these analyses should be interpreted cautiously given the small number of studies and substantial heterogeneity.
CONCLUSIONS: .Available observational evidence suggests that nasal surgery may be associated with measurable alterations in vocal resonance. Septoplasty was associated with increased nasalance (pooled increase 17.2 percentage points, 95% CI: 15.0-19.4), while rhinoplasty studies reported variable changes in higher formant frequencies and turbinoplasty studies reported intermediate acoustic effects. The clinical significance of these changes remains uncertain, and limited observational evidence suggests that professional voice users may be more sensitive to subtle acoustic alterations. Preoperative counseling should address potential voice changes, particularly for individuals with high vocal demands. Future research should employ standardized acoustic protocols and longer follow-up periods to better characterize recovery trajectories and identify patient subgroups at risk for clinically significant voice alterations.