This Article Has Been Medically Approved By

Dr. George H. Sanders

Nasal surgery, also known as rhinoplasty, is a popular plastic surgery procedure. In 2012 one out of every 1,250 persons in the U.S. underwent rhinoplasty. Benefits from this surgery include improvement in nasal appearance, better nasal breathing, and an improved sense of smell. But if you’re a professional singer, you may be concerned with its effect on your voice. Barbara Streisand chose not to have nasal surgery for that reason. On the other hand, countless others have had successful rhinoplasties – Dean Martin and Milton Berle, to name a few. So who’s right?

A recent article in the February 2014 edition of Plastic & Reconstructive Surgery examines this topic in further detail. The authors are from Iran where nasal surgery is done twice as frequently as in the U.S. – No, the Ayatollah Khomeini is not one of them! They selected 27 patients for their study who were not having any work done to improve their breathing, only having surgery for cosmetic nasal improvement. Six of these patients were professional singers. All of the patients had a narrowing of the nasal bones, removal of a nasal hump, and narrowing of the nasal tip. Speech analysis was performed, both before and 5 months after surgery, on all patients. This consisted of a patient questionnaire, a computerized voice analysis, and a voice analysis by six trained listeners.

The results:

The trained listeners noted that patients’ voices became more “hyponasal” after surgery, the way you sound when you have a “stuffy nose.” The authors reason that this was because the internal nose was narrowed by inward movement of the nasal bones, a maneuver that is often done to narrow an excessively wide nasal bridge. This is theorized to result in a decrease in nasal airflow during speech that is perceived as “sounding nasal.”

– Questionnaires showed that patients noticed voice changes after surgery, but that these changes did not affect their ability to function.

– Computerized analysis  showed changes in the pronunciation of certain sounds.

But what do doctors in the U.S. who treat professional singers have to say? (See Reuters)

– When properly done, nasal surgery will increase airflow through the nose, resulting in a clearer sound and a lesser need for diaphragmatic support.

– In the classically trained American style of singing, you sing from the chest and the throat, not the nose. For that reason, minor changes in the nose will not affect the voice.

Virtually no singers who have undergone rhinoplasty express concern over changes in their voice, specifically concerning voice nasality.

What are my thoughts? Since the changes in voice are due to a narrowing of the nasal air passage by narrowing of the nasal bones, I avoid this maneuver in any patient who expresses concern over their voice. I also avoid intubation of the patient during surgery, avoiding potential trauma to the vocal cords. By following these two simple rules, I have never had any patients complain of voice change after surgery, even professional vocalists.

I would also like to know specifically what the 6 patients in the study who were professional singers noted after surgery. Curiously, the authors do not mention this!

Your thoughts?

George Sanders, M.D.