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Does a nose job affect the voice?

By Kathleen Raven

NEW YORK (Reuters Health) - People who went under the knife for nose jobs sounded a bit more nasal five months after the surgery, according to a new study from Iran.

The results from 27 surgeries showed that "the voices changed in statistically significant ways, but the changes were subtle," Dr. Kamran Khazaeni told Reuters Health.

Khazaeni, a surgeon who specializes in ear, nose and throat procedures, worked on the study at Mashhad University of Medical Sciences in Iran.

The 22 female and five male patients "noticed changes, but overall, they were satisfied," Khazaeni said. Patients ranged in age from 18 to 45 years old.

A team of linguists and speech pathologists detected more pronounced nasal sounds in test words like "man" and "namak" post-surgery after listening to voice recordings of the patients. Persian, the official language of Iran, has no nasal vowels, but does have nasal consonants - like the "m" in "man" and the "n" in "namak" - said Khazaeni, explaining why the group focused on those two words.

The results were confirmed with patient self-assessments and a computer program that analyzes acoustic sounds.

About one in 560 Iranians had cosmetic nose surgery in 2011. By comparison, about one in 1,250 U.S. men and women had the same procedure in 2012, according to national surveys from both countries.

Writing in the February issue of Plastic and Reconstructive Surgery, Khazaeni and his team say that if nose jobs, also called rhinoplasties, can change vocal sounds by narrowing a person's nasal cavity, people who rely on their voice for professional reasons should be made aware of this possible risk.

But Dr. Steven Pearlman, a facial plastic surgeon based in New York City who was not part of the current research, disagreed, at least in cases where patients are singers.

"The better trained the singer is, the less the nose has to do with it," Pearlman said.

"I've operated on patients who are rock stars, Broadway stars and opera singers," Pearlman told Reuters Health. "And in the classically trained American style of singing, you sing from the chest and the throat, not the nose," he said, adding that speaking is different from singing and perhaps Middle Eastern methods of singing rely more on the nasal cavity for sound.

Regarding the study, the idea and goal were good, "but the execution was limited," Pearlman said.

An important missing element is nasal airflow measurements taken on each patient before and after the surgery in order to detect changes in how air passes through the nose.

"Without this measurement, you may have airflow changes, but you don't know," he said.

The study raises interesting questions, such as why these results are being seen in Iran and not in North America, said Dr. Minas Constantinides. Anecdotally, of the more than 2,000 rhinoplasties he has performed, Constantinides said only one patient expressed concerns about more voice nasality after surgery.

Constantinides practices facial plastic surgery in New York City and is secretary of the American Academy of Facial Plastic and Reconstructive Surgery. He was not involved in the new research.

"I don't think these results can be broadly applied to rhinoplasty," he said. But, the current study "raises enough questions to bear being repeated" with larger groups of patients at a medical center in the U.S., he said.

"Rhinoplasty is one of the hardest procedures to do in facial plastic surgery," Constantinides said, adding that people need to carefully research surgeons before moving forward with the procedure.

"Patients understand that surgery always has some risk attached to it," he said. "However, voice change is not something that patients need worry about in competent hands."

SOURCE: http://bit.ly/1n8AuS1 Plastic and Reconstructive Surgery, online January 28, 2014.

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