Note: This week, I move from the University of California, San Francisco to the University of Southern California in Los Angeles. I was born and raised in Los Angeles, and this change is solely for personal (non-work) reasons. I look forward to joining the team at USC, where I will continue the combination of caring for patients and performing research to advance the field of sleep surgery. I am excited about the challenges and opportunities that the move will bring.
The July 2013 issue of the medical journal Otolaryngology–Head and Neck Surgery had an article evaluating the changes in voice after soft palate surgery (uvulopalatopharyngoplasty) with and without tongue surgery (tongue radiofrequency). Because sleep apnea surgery can involve removal, repositioning, and/or stiffening of tissues of the surrounding the throat, there is the possibility of changes in voice, even if no work is done on the voice box (larynx) directly. The research was performed by a group led by Dr. Sung Wan Kim, a surgeon at Kyung Hee University Hospital in Seoul whom I know from sleep surgery conferences, including his own where I spoke in October 2012. Sung Wan is a vocational singer (apparently quite good), leading to his interest in the topic.
This was the first study to consider voice changes after sleep apnea surgery performed on the tongue. Overall, the results were similar to previous research: changes occurred but were fairly subtle in both groups. There were no changes in the key features of voice (fundamental frequency, jitter, shimmer, maximal phonation time, and noise-to-harmonic ratio). There were changes in some of the formants, reflecting changes in the resonance of the throat. There was a change in an overall measure of voice in the group that underwent both procedures, but in only 1 (out of 25) patients was the change what would be considered meaningful to typical voice users.
The bottom line: the change in voice is not noticeable for most patients who have sleep apnea surgery
There may be changes in voice after these procedures, but the changes are unlikely to be noticed for most patients. Based on previous studies, I have always told my patients that professional voice users (like me) will likely not notice much of a difference in their voice. However, vocational and professional singers may notice these subtle differences because of the greater demands they place on their voice. I have never had a patient report a noticeable change in their speaking or singing voice after soft palate surgery or any tongue surgery except the most-aggressive approach (midline glossectomy) where I physically have to remove a substantial part of their tongue. However, the risk exists and is something to consider, especially for singers.
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Andrei D says:
Eric, have there been any studies to see if singers or people who have to speak more than an average person have lower chances of developing sleep apnea? It would seem possible that using the tongue more could help make it stronger (just like any other muscle in our body) and thus less likely to relax and fall back during sleep.
Dr. Kezirian says:
There has been work done in Brazil on oropharyngeal exercises, and the limited (but encouraging) results for the didgeridoo suggest that there may be a role for muscle-strengthening exercises. However, one study looked at musicians who play reed instruments and found no effect on the risk of OSA. Speaking would not be expected to do much, although singing potentially would. I am not aware of any studies of singers.
Steven Wu says:
Hi,Eric:
I am Steven from Taiwan and glad to hear you move to USC. Interesting, I just experienced one patient had grade lV tonsils and I performed U3P for her snore. After U3P, her muffled voice got changed to soft and tender!
Dr. Kezirian says:
Steven, this is a great point. Patients with very large tonsils can have all sorts of voice changes, including muffling. Removing these very large tonsils can result in these types of changes, but I would say that studies suggest these major changes in voice are related to tonsillectomy rather than what was done to the soft palate.
Deborah Wardly says:
hi Dr. K; you did my midline glossectomy a few years ago, and I have NOT noticed a change in my singing voice. I wasn’t able to sing much for awhile due to my intracranial hypertension and the valsalva effect, however I am much better now and singing is just fine.
also, I found a study recently that I think was published in 2012, that did show that double reed instrument players had less OSA than non wind instrument players. I started my 7 yr old daughter on oboe lessons, and within 4 months her chronic cough was gone, her dental decay stopped, she stopped snoring and mouth breathing at night and said she felt better during the day. we had trouble with myofunctional therapy but I found that oboe practice was a better substitute and the final key to getting a handle on her sleep breathing. this is after T&A, maxillary expansion, and mandibular advancement with Biobloc. love that oboe!
congrats on your move!
Deb
Dr. Kezirian says:
I am glad you had no change in your voice and just as happy to hear about your daughter. The study you mentioned is from Ward in the Journal of Clinical Sleep Medicine. Wind instrument players did not have less sleep apnea, but double reed instrument players did. The work is certainly preliminary, but I so glad your daughter is doing so well with the oboe.