After rhinoplasty, patients perceive differences in voice quality, but not in function

Patients who have undergone plastic surgery to change the appearance of their nose may also notice changes in the sound of their voice, reports a study in the February issue ofPlastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Changes in voice after rhinoplasty are perceptible to patients as well as to experts, but generally don’t cause problems with speech function, according to the new research by Dr. Kamran Khazaeni and colleagues of Mashhad University of Medical Sciences, Iran. However, they believe that patients considering rhinoplasty – especially those who use their voice professionally – should be aware of “potential voice alterations.”

Patients Perceive Voice Changes after Rhinoplasty

The researchers analyzed changes in voice quality in 27 patients undergoing rhinoplasty at two hospitals in Iran, where rhinoplasty is one of the most popular cosmetic procedures. The patients were 22 women and five men, average age 24 years. Twenty-two percent of the patients used their voice professionally.

After rhinoplasty, patients completed a standard questionnaire to rate perceived problems with their voice. In addition, recordings of the patients’ voices made before and after rhinoplasty were compared by trained listeners, who were unaware of whether they were hearing the “before or after” recordings.

The questionnaire responses showed worsening in some areas of voice quality: particularly in the physical and emotional subscales, reflecting patients’ perceptions of their voice and their emotional responses to it. There was no change on the functional subscale, reflecting the effects of voice on daily activities.

The trained listeners also perceived changes in voice quality, including an increase in “hyponasality” following rhinoplasty. Hyponasal speech reflects the sound of the voice when not enough air is moving through the nasal cavity – for example, in a person with a stuffy nose. “This observed increase in hyponasality perception demonstrates that the change in the patients’ voices is perceptible to trained listeners, but does not address whether this change is apparent in everyday life and in routine conversations,” according to Dr. Khazaeni and colleagues.

Changes May Reflect Narrowing of Nasal Cavity

An acoustic analysis suggested changes in the frequency and amplitude of certain sounds, which may be related to narrowing of the nasal cavity after rhinoplasty. “The changes in surface area of nasal cavity may increase airflow resistance and cause an increase in sound absorption and a decrease in passing sound amplitude,” according to the researchers.

With recent advances in surgical technique and long-term outcomes, rhinoplasty has become an increasingly popular procedure in Iran, as in other countries. The growing number of patients undergoing this cosmetic surgery raises concerns about how it might affect various functions and quality of life. “Recently we have noticed patients who use their voice professionally asking if rhinoplasty changes their voice,” Dr. Khazaeni and coauthors write.

Based on the new results, the answer seems to be that changes in voice quality do occur after rhinoplasty. Subtle but significant changes are apparent to trained listeners. Patients themselves may also perceive changes to some extent, although they don’t seem to cause interference in the patient’s lives. “However, for individuals who rely on their voice for professional reasons, the surgeon should discuss these changes with the patient preoperatively and consider more conservative types of surgery,” the researchers conclude.

http://www.medicalnewstoday.com/releases/271894.php

Photo courtesy to Mayo Foundation

 

Pediatric ear infections cost health care system nearly $3 billion a year

Acute otitis media, or ear infection, is the most common ailment among kids of preschool age and younger in the U.S., primarily because these children have immature middle-ear drainage systems, higher exposure to respiratory illnesses and undeveloped immune systems.

And because it’s also the most common reason for antibiotic use among all children, the costs associated with acute otitis media (AOM) are under more scrutiny than ever by health care and government administrators, especially given today’s political and economic climate, strained health-care resources and cost-containment efforts.

While estimates of the economic impact of AOM have been formulated in the past, a new study by UCLA and Harvard University researchers is the first to use a national population database that gives a direct, head-to-head comparison of expenditures for pediatric patients diagnosed with ear infections and similar patients without ear infections.

The findings show that AOM is associated with significant increases in direct costs incurred by consumers and the health care system. With its high prevalence across the U.S., pediatric AOM accounts for approximately $2.88 billion in added health care expenses annually and is a significant health-care utilization concern.

The research is published in the current edition of the journal The Laryngoscope.

“Although the annual incidence of ear infection may be declining in the U.S., the number of kids affected remains high, and the public health implications of AOM are substantial,” said study co-author Dr. Nina Shapiro, director of pediatric otolaryngology at Mattel Children’s Hospital UCLA and a professor of head and neck surgery at the David Geffen School of Medicine at UCLA. “As our health care system continues to be vigorously discussed around the nation, efforts to control costs and allocate resources appropriately are of prime importance.”

For the study, the researchers examined records of pediatric patients under the age of 18 culled from the 2009 Medical Expenditure Panel Survey, a national survey conducted by the Agency for Health Research and Quality which serves a benchmark data-set specifically designed for the assessment of health care costs.

Of the 81.5 million children the researchers sampled, 8.7 million had received care for ear infections. The rates of visits to the doctor’s office, refills of prescription medications and health care costs associated with doctor visits were then compared between those with diagnosed ear infections and those without. The rates were adjusted for age, sex, region, race, ethnicity, insurance status and co-morbidities.

The researchers found that children with ear infections had an average of two additional outpatient visits, 0.2 emergency visits and 1.6 prescriptions filled, compared with those without ear infections.

Ear infections were associated with an incremental increase of $314 per child annually for outpatient health care and an average of $17 in additional costs for medications. This resulted in an overall $2.88 billion annual cost for ear infections.

“Although certain immunizations that target infection-causing bacteria may play a role in slightly reducing the overall rate of ear infections, millions of young kids will still have them,” Shapiro said. “The take-home message is that the common ear infection is an extremely costly entity with significant financial burdens on the health care system.”

Future studies on the health care cost associated with AOM may include analyzing the indirect costs, such as work and school days missed, gasoline costs and parking charges for outpatient visits, the researchers said.

http://www.medicalnewstoday.com/releases/271084.php

Picture courtesy of www.healthofchildren.com