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
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.
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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
"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."
Plastic and Reconstructive Surgery, online Jan. 28, 2014.
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