title: Hypernasality after using the endoscopic endonasal transsphenoidal approach for skull base tumors.
abstract: OBJECTIVE
  The increasing number of endoscopic endonasal transsphenoidal approaches (EETSA) has resulted in several sinonasal complications, including voice changes. Here, we compared preoperative and postoperative voice changes according to age.
  
  
  METHODS
  We retrospectively reviewed the medical records. Patients were divided into the following three groups according to age: ≤ 30 years, 31 to 60 years, and ≥ 60 years. Patients underwent preoperative voice evaluation using acoustic analysis, a nasometer, and the voice handicap index (VHI). A nasometer was used to measure the nasalance scores. The subjects read or repeated three speech stimuli. For each stimulus, mean nasalance scores were obtained and age dependence was analyzed. Repeat testing was performed 6 months postoperatively.
  
  
  RESULTS
  One hundred and seventy patients who underwent binostril four-hand EETSA with a bilateral modified rescue flap were included in this study. Mean nasalance scores for the oral passage, oronasal passage, and nasal passage--as well as mean jitter scores, shimmer scores, and VHI--were significantly increased in all of the EETSA patients (P < 0.05 for all). Mean nasalance scores for the nasal sentences were significantly increased in the ≤ 30 age group (all, P < 0.05). Scores for the oronasal passage and nasal passage were significantly increased in the 31 to 60 age group (all, P < 0.05). Scores for the oronasal passage, nasal passage, jitter, and shimmer were significantly increased in the > 60 age group (all, P < 0.05).
  
  
  CONCLUSIONS
  Endoscopic endonasal transsphenoidal approaches might contribute to voice changes. In addition, older age might produce hypernasality and roughness after EETSA. Patients who plan to undergo EETSA should be informed that their voice may change after the operation.
  
  
  METHODS
  4.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Boo-Young
authors.initials: BY
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Ji-Hyeon
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.|Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital.|Department of Biomedical Science, The Catholic University of Korea, College of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Won
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery.
authors.forename: Yong Kil
authors.initials: YK
authors.lastname: Hong
authors.affiliation: Department of Neurosurgery.|Minimal Access and Robotic Surgery Center, Seoul St. Mary's Hospital.
authors.forename: Sin-Soo
authors.initials: SS
authors.lastname: Jeun
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Soo Whan
authors.initials: SW
authors.lastname: Kim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Jae Hyung
authors.initials: JH
authors.lastname: Hwang
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Soon-il
authors.initials: SI
authors.lastname: Yoo
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Yong Joo
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Mi-Ran
authors.initials: MR
authors.lastname: Shim
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery.
authors.forename: Yeon-Shin
authors.initials: YS
authors.lastname: Hwang
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D057605:Natural Orifice Endoscopic Surgery / Q000379:methods*; D009666:Nose; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013101:Sphenoid Sinus; D014057:Tomography, X-Ray Computed
keywords: Endoscopic endonasal transsphenoidal approach; age; hypernasality; voice change