The Effects of Intraoperative Local Tranexamic Acid on Periorbital Edema and Ecchymosis in Septorhinoplasty.

INTRODUCTION: The aim of the present study is to examine the effect of local administration of tranexamic acid (TXA) through lateral osteotomy line on postoperative periorbital edema and ecchymosis. MATERIALMETHOD: Thirty patients underwent open technical septorhinoplasty were included. Before lateral osteotomies, the surgeon opened narrow subperiosteal tunnels on the both sides. After lateral osteotomies, the surgeon irrigated TXA into the right tunnel with the broken tip of the injection and the same amount of saline into the left tunnel. The patient's photographs were taken on the first, third, and seventh postoperative days. Periorbital edema and ecchymoses were evaluated by the blinded author. The statistical differences between the 2 sides were analyzed. RESULTS: Lower Eyelid Edema values were significantly lower in the TXA(+) group than the TXA(-) group on the third day (P = 0.001). There was no statistically significant difference between the sides in terms of lower eyelid edema values on the first and seventh days (P = 0.065, P = 0.317). Upper and lower eyelid ecchymosis values were significantly lower in TXA(+) group than TXA(-) group on the first, third, and seventh days (P < 0.05). Upper eyelid edema values were found to be significantly lower in the TXA(+) group than the TXA(-) group on the first and third days (P = 0.002, P = 0.005). There was no statistically significant between the sides in terms of upper eyelid edema (P = 0.315) on the seventh day. CONCLUSIONS: It was observed in the present study that local administration of TXA in septorhinoplasty was effective in reducing postoperative periorbital edema and ecchymosis.Level of evidence: 2c.

Effects of supplementation of dietary humate, probiotic, and their combination on performance, egg quality, and yolk fatty acid composition of laying hens.

This study was carried out to determine the effects of addition of humate, probiotic, and their combination into diets on performance, egg quality, and yolk fatty acid composition of hens during the second laying period. Lohmann LSL white layers (n = 192), 46 weeks of age, were randomly divided into 4 groups and fed with basal diet (control, C), 0.3% humate (H), 0.3% probiotic (P), 0.15% humate + 0.15% probiotic (HP) for 18 weeks. Feed consumption and egg production were determined daily, egg weight was measured biweekly, and body weights were recorded at the beginning and the end of the experiment. Also, 12 egg samples from each group were randomly collected to determine the egg quality every 30 days. Laying performance, yolk color, and fatty acid composition were significantly (P < 0.05 and P < 0.01) affected by addition of humate, probiotic, and their combination into diets of layers. The HP group had higher cracked egg yield and feed conversion ratio values than control and H and P groups. Except for egg yolk color, the other egg quality parameters such as shape index, shell strength, shell thickness, albumen index, yolk index, and Haught unit were not affected by treatment (P < 0.05 and P < 0.01). The egg yolks of treatment groups had less stearic acid than those of control group. In conclusion, supplementation of humate and probiotic into the diets of laying hens increased monounsaturated fatty acids in yolk and improved feed conversion ratio and egg yolk color.

Relationships among concha bullosa, nasal septal deviation, and sinusitis: Retrospective analysis of 296 cases.

We aimed to investigate the relationships among concha bullosa (CB), nasal septal deviation (NSD), and sinus disease. We retrospectively reviewed paranasal sinus computed tomography scans obtained from 296 patients-132 men and 164 women, aged 17 to 76 years (median: 39)-who had been evaluated over a 19-month period. CBs were classified as lamellar, bulbous, and extensive. In cases of bilateral CB, the larger side was designated as dominant. In all, 132 patients (44.6%) exhibited pneumatization of at least one concha, 176 (59.5%) had NSD, and 187 (63.2%) had sinus disease. Some 89 of 106 patients with unilateral or one-side-dominant CB (84.0%) had NSD, 89 of 132 patients with CB (67.4%) had sinus disease, and 109 of the 176 patients with NSD (61.9%) had sinus disease. We found a statistically significant relationship between CB and contralateral NSD, but no significant relationship between CB and sinus disease or NSD and sinus disease. While CB is a common anatomic problem that may accompany NSD, a causal relationship between CB or NSD and sinus disease is dubious.

How can periorbital oedema and ecchymose be reduced in rhinoplasty?

Oedema and ecchymose are frequent morbidities of septorhinoplasty, a facial surgical procedure for reforming the shape and functions of the nose. Periorbital oedema (PO) and periorbital ecchymose (PE) are normal occurrences, but are undesirable for patients undergoing the procedure for aesthetic purposes. The present study examined 65 patients who underwent open technique septorhinoplasty for aesthetic and functional complaints. Patients were divided into two groups: Group 1 patients underwent lateral osteotomy following tip plasty, at the end of the surgical operation; Group 2 patients underwent lateral osteotomy before tip plasty, at the beginning of the surgical operation. Patients were followed on the postoperative first, third and seventh days. PO and PE values of patients were scored from 0 to 4. The plastering time (Pt) was significantly shorter for Group I than Group II (p < 0.05). The total surgical time (T) showed no significant difference (p > 0.05). The PO value at the first, third and seventh days was significantly smaller for Group I than Group II (p < 0.05). The PE value at the first, third and seventh days was also significantly smaller for Group I than Group II (p < 0.05). The obtained data indicate that performing a lateral osteotomy in the final stages of surgery, and subsequently applying a nasal plaster and splint as rapidly as possible, decreases PO and PE in the postoperative period.

The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients.

BACKGROUND: In this prospective, multicenter, randomized, controlled, double-blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients. METHODS: In total, 327 patients with diagnoses of persistent AR or mild-to-severe persistent asthma were randomized into 2 intervention groups and 2 control groups upon their admission at outpatient clinics. The intervention groups (POPET-AR and POPET-Asthma) received a mobile phone application ("physician on call patient engagement trial" [POPET]), enabling them to communicate with their physician, and record their health status and medication compliance. The AR groups completed the Rhinitis Quality of Life Questionnaire (RQLQ) at initiation and at the first month of the study. The asthma groups completed the Asthma Control Test (ACT) at initiation and at the third month of the study. RESULTS: The POPET-AR group showed better clinical improvement than the control group in terms of the overall RQLQ score as well in measures of general problems, activity, symptoms other than nose/eye, and emotion domains (p < 0.05). In the POPET-Asthma group, more patients (49%) achieved a well-controlled asthma score (ACT > 19) compared with the control group (27%); this was statistically significant (p < 0.05). CONCLUSION: Use of a mobile engagement platform, such as POPET, can have a significant impact on health outcomes and quality of life in both AR and asthma, potentially decreasing the number of hospital admissions, repeat doctor visits, and losses in productivity. Improvements were seen in domains related to activity, productivity, perception of disease, and emotion.

Histopathologic changes in the middle ear mucosa after exposure to pepsin and unconjugated bile acid.

OBJECTIVE: An increasing number of studies indicate that pepsin and bile acid cause damage to the ear, nose, and throat structures as a result of extraesophageal reflux. The aim of this study was to evaluate and compare the damaging effect of bile acids and pepsin on the middle ear mucosa. MATERIAL AND METHODS: Twenty-nine healthy rats were included in this study. The animals were divided into 5 groups. A single daily dose of 40 µmol/L chenodeoxycholic acid, 40 µg/mL pepsin, and saline were injected separately into the right middle ear of the rats. On day 30, all rats were decapitated, and formalin-fixed, paraffin-embedded samples of the middle ear both from the control and experimental rats were prepared. A semiquantitative analysis was performed. RESULTS: Inflammatory response was seen in all middle ear mucosa of rats except control group 1. The degree of inflammatory response was higher in the bile acid group when compared with the other groups. Epithelial metaplastic changes with varying number of goblet cells were observed in both the bile acid- and pepsin-injected groups. These metaplastic changes were also higher in the bile acid-induced group than in the pepsin-injected group. CONCLUSIONS: This is the first study on the middle ear mucosal damage of both pepsin and bile acid. Our results demonstrate that bile acids were associated with more extensive mucosal injury at pH 7 in comparison to pepsin in a rat animal model. Inflammatory response and metaplastic changes may play an important role in the etiology of middle ear pathologies.

Does rhinoplasty reduce nasal patency?

OBJECTIVE: This study aimed to evaluate the effect of rhinoplasty on subjective and objective assessment of nasal patency in patients who underwent rhinoplasty for cosmetic reasons only. SETTING: Tertiary referral center. DESIGN: Prospective, clinical study. SUBJECT AND METHODS: A total of 50 adult patients who underwent rhinoplasty were included in the study. Preoperative and postoperative photographs of the nasal profile (frontal, lateral, and oblique) were obtained. The visual analog scale (VAS) was used for the subjective evaluation of nasal obstruction (0 being the minimum, 10 being the maximum amount of nasal patency). Objective evaluation of nasal obstruction was performed with a peak nasal inspiratory flowmeter (PNIF). RESULTS: Preoperative mean VAS scores and PNIF values of the patients were 7.36 ± 0.83 and 115.10 ± 17.45, respectively. Postoperative mean VAS scores and PNIF values of the patients were 7.42 ± 0.73 and 115.30 ± 16.7, respectively. There was no statistically significant difference between any of the pre- and postoperative subjective and objective parameters (P > .05). CONCLUSION: Reduction rhinoplasty has been shown not to reduce nasal patency.

Changing strategies in the treatment of maxillofacial fractures at thrace region: open vs closed reduction.

OBJECTIVE: We aimed to analyze etiological factors in patients with maxillofacial trauma, treatment modalities, complications related to surgical approaches and the changing patterns in over time. MATERIALS AND METHODS: A total of 126 patients diagnosed as maxillofacial fractures between August 1998 and June 2012 were investigated in Corlu State Hospital, Ear Nose Throat and Plastic Surgery Clinics, retrospectively. RESULTS: Of the patients, 92 male (73.01%) and 34 female (26.98%), the mean age was 26.4 (± 14.88). Traffic accidents as a cause of fracture were detected in 47 (37.3%) cases. The other causes were assaults in 34 (26.98%), sport injuries in 23 (18.25%), fall from high in 12 (9.52%) and work-related accidents in 10 (7.93%) patients, respectively. In patients with maxillofacial fractures, 65 (51.58%) of them were nasal, 37 of them were (29.36%) mandible, 6 of them were (4.26%) maxilla, 8 of them (% 6.34) were isolated zygomatic arch fractures. Multiple fractures were detected only 10 patients (7.93%). As a surgical method, closed reduction in 75 (59.52%), open reduction and internal fixation in 29 (23.01%), inter-maxillary fixation with open reduction and internal fixation in 13 (10.31%) and only inter-maxillary fixation in 9 (7.14%) cases were performed. Complications were detected as 10.31% of patients in postoperatively. CONCLUSION: Open and closed reduction techniques are safe and successful methods. While closed reduction of mandibular fractures was used as a surgical method previously, combined approaches are now being applied instead of it.

Effect of thermal welding tonsillectomy on emergence agitation.

: This study sought to examine the effect of thermal welding tonsillectomy that reduces pain and length of anesthesia on emergence agitation. A total of 60 patients (age range, 3­6 years) with chronic recurrent tonsillitis with an indication for tonsillectomy were included. Patients were randomly assigned to 2 groups. The control group (the CD group) was composed of patients undergoing cold dissection (CD) tonsillectomy. The study group (TW group) included patients undergoing thermal welding (TW) tonsillectomy. All patients were given sevoflurane as an anesthetic agent. For all patients, anesthesia time, operation time, extubation time, Pediatric Anesthesia Emergence Delirium scale, pain scale, nausea/vomiting score, and delivery time were recorded. The duration of anesthesia, operation, and delivery was significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). The pain and agitation scores were significantly lower in the TW group as compared with the CD group (P = 0.000 < 0001). We assume that, besides reducing pain and allowing surgery without bleeding, the TW tonsillectomy method diminishes emergence agitation induced by anesthetic agents, such as sevoflurane.

A rare tumor of the parapharyngeal space: angiomyxolipoma.

Parapharyngeal space tumors are uncommon, most are salivary gland tumors (50%), and they are often pleomorphic adenomas. Neurogenic tumors are the second most common primary tumors of all neoplasms in the parapharyngeal space (30%). Angiomyxolipoma is a very rare form of lipoma. Up until now, only 12 cases located on different sides of the body were reported. Presented here is a case report of a patient with an angiomyxolipoma of the parapharyngeal space. A 17-year-old boy had a slowly growing, painless mass on the left side of the neck. During the oropharyngeal examination, medial displacement of the left tonsilla palatina was observed. Magnetic resonance imaging findings were of a 6 × 5.5 × 3-cm "dumbbell"-shaped parapharyngeal mass. A fine needle aspiration of the mass showed no specific histopathology. The patient underwent a transparotid-transcervical approach for the excision of the tumoral mass under general anesthesia. Although an angiomyxolipoma is a rare form of lipoma, it is a pathology that should be kept in mind for the differential diagnosis of parapharyngeal tumors.

Efficacy of dexpanthenol for pediatric post-tonsillectomy pain and wound healing.

OBJECTIVES: We evaluated the efficacy of dexpanthenol in managing pediatric post-tonsillectomy pain and wound healing and sought to discover which of two surgical tonsillectomy techniques provides better healing and less postoperative pain. METHODS: One hundred twenty patients who underwent tonsillectomy were equally randomized to thermal welding and cold dissection groups. Dexpanthenol pastilles were given to half of each group. Postoperative throat pain was determined with a visual analog scale on the 1st, 3th, 7th, and 14th days, and mucosal healing patterns were assessed on the 7th and 14th days. RESULTS: Regardless of surgical technique, post-tonsillectomy throat pain was significantly less in the dexpanthenol groups than in the placebo groups (p < 0.05), and tonsillar wound healing was significantly better in the dexpanthenol groups than in the placebo groups (p < 0.05). When a comparison was made with regard to surgical technique, wound healing was significantly better in the cold dissection group (p < 0.05), whereas postoperative throat pain was less in the thermal welding group (p < 0.05). CONCLUSIONS: Postoperative administration of dexpanthenol significantly accelerates the wound healing process and decreases tonsillectomy-related pain complaints.

The effect of the duration of merocel in a glove finger on postoperative morbidity.

We examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

Normal range of peak nasal inspiratory flow and its role in nasal septal surgery.

Nasal obstruction can be evaluated by objective and subjective methods. We sought to determine normative peak nasal inspiratory flow meter (PNIF) measurements of a healthy population in Turkey and to investigate the importance of PNIF in surgery for nasal septal deviation as well as to investigate the correlation of PNIF with subjective methods. In a total of 269 patients, 50 patients underwent septoplasty and 219 control subjects were enrolled in the study. Data on preoperative and postoperative PNIF measurements, nasal septal indices, and subjective measurements (visual analogue scale, VAS) were recorded. Mean PNIF value was 137.8 L/min in control subjects. Postoperative PNIF, VAS, and nasal septal index data were statistically significantly higher in the study group as compared with those of preoperative data. We found PNIF, VAS, and nasal septal indices of the control group to be consistent with postoperative data and to be higher than preoperative data of the study group. We identified a normal PNIF range for the healthy Turkish population and we saw that the data were compatible with VAS scores. PNIF seems to be a very effective method in the evaluation of nasal obstruction and in deciding operation.

Effects of Ramadan fasting on serum immunoglobulin G and M, and salivary immunoglobulin A concentrations.

OBJECTIVE: To investigate the effects of Ramadan fasting on serum concentrations of immunoglobulin (Ig)G and IgM, and salivary IgA concentrations. METHODS: Blood and saliva samples were collected one week before and during the last week of Ramadan from healthy male volunteers. Albumin, total lymphocyte count, electrolytes, and IgG and IgM concentrations were determined in serum; salivary IgA concentrations were measured. Anthropometric measurements were also recorded. RESULTS: Samples were collected from 35 subjects (mean age 35.86 years, range 20-59 years). Weight, body mass index, albumin levels and the nutritional risk index decreased significantly during Ramadan fasting compared with before fasting. In addition, Na(+) and Cl(-) electrolyte levels were significantly decreased during Ramadan. Serum IgG concentrations decreased significantly during Ramadan compared with before fasting, but were still within the normal range. Salivary IgA concentrations also decreased significantly, whereas serum IgM levels did not change. Lymphocyte numbers increased significantly, but there was no correlation between Ig levels and lymphocyte count. CONCLUSION: Ramadan fasting did not result in severe immunological disturbances.

Voice and speech changes in various phases of menstrual cycle.

BACKGROUND: The reproductive system in females undergoes a regular cyclic change known as the menstrual cycle. Laryngeal changes are evident and fluctuate systematically during the reproductive years with the menstrual cycle. The impact of estrogens in concert with progesterone produces the characteristics of the female voice, with a fundamental frequency (F(0)) higher than that of male. OBJECTIVE: To characterize changes in voice and speech in adolescent females in different phases of the menstrual cycle--during menstruation, after menstruation, mid-menstrual cycle, and premenstruation. MATERIALS AND METHODS: Sixteen adult females who were nonusers of oral contraceptives participated in a cross-sectional study of menstrual cycle influences on voicing and speaking tasks. Acoustic analysis (F(0), intensity, perturbation measurements [jitter and shimmer], and harmonic-to-noise ratio), maximum phonation time (MPT), s/z ratio, and perceptual assessments (grade [G], roughness [R], breathiness [B], asthenia [A], and strain [S] [GRBAS] and Voice Handicap Index-10 [VHI-10]) scales were performed during all phases. RESULTS: None of the acoustic analysis parameters and MPT and s/z ratio measurements revealed statistically significant difference (P > 0.05). Perceptual voice assessment scales either clinician based or patients self-evaluated showed significant differences among phases (P < 0.05). CONCLUSIONS: The objective voice analysis methods, such as acoustic analysis, MPT, and s/z ratio, determined no difference; however, the subjective voice analysis methods, such as clinician-based perceptual assessment (GRBAS) and patients self-evaluation (VHI-10) scales, demonstrated significant changes during different phases of menstrual cycle.

The role of mometasone furoate nasal spray in the treatment of adenoidal hypertrophy in the adolescents: a prospective, randomized, cross-over study.

Aim of this work is to find out whether the symptoms attributable to adenoid hypertrophy in adolescents may be treated with intranasal mometasone furoate (MF) application. To learn if adenoid hypertrophy in adolescents may decrease in size with intranasal MF. A prospective, double blind, randomized, cross-over study was conducted in 28 subjects (12-18 years) with adenoidal hypertrophy. Subjects used intranasal MF or placebo for a duration of 6 weeks with a wash out period of 3 weeks. Subjective symptoms and adenoid size were evaluated. At the initiation of the study, there was no significant difference between the mean symptom scores for any of the sinonasal symptoms between the two treatment groups. There was significant improvement in total subjective symptoms (nasal blockage, rhinorrhea, cough, snoring and disruption of quality of life scores) with MF compared with placebo. Analysis of the symptoms separately showed a significant positive effect of MF on all symptoms except for rhinorrhea. Nasal endoscopic evaluation failed to demonstrate any difference in the reduction of the adenoid size between the two groups. MF has significant advantage over placebo for the symptoms attributable to adenoid hypertrophy in adolescents.

External auditory canal microbiology and hearing aid use.

OBJECTIVE: The aim of this study was to determine the presence and nature of bacterial flora on hearing aids and the ears of this population. We wonder if the microbiology of the ears with hearing aid wearing differs from the other ear. SETTING: Tertiary referral center. DESIGN: A prospective, clinical study. SUBJECTS AND METHODS: Three samples were taken, one from the surface of the hearing aid's ear mold; one from the hearing aid-wearing ear canal and the last one from the ear without hearing aid. Samples were cultured to determine qualitatively and quantitatively the pathogenic microorganisms present. RESULTS: A total of 123 samples, obtained from 41 hearing aid users, were analyzed. Methicillin-resistant coagulase-negative staphylococci, methicillin-susceptible Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter species, Staphylococcus auricularis, and Stenotrophomonas maltophilia were identified organisms. CONCLUSIONS: We identified unexpected microorganisms both on hearing aids and hearing aid using ears. This study demonstrates that using hearing aid alters the ear canal flora. To avoid otitis externa, it is important to use an appropriate hygiene routine to clean and disinfect hearing aids and ear molds.

Does cooling the tonsillar fossae during thermal welding tonsillectomy have an effect on postoperative pain and healing?

The objective of this study was to evaluate the effect of cooling the tonsillar fossa during thermal welding tonsillectomy on pain and wound healing. Prospective, blinded, clinical study was conducted. 30 patients who underwent tonsillectomy by thermal welding were evaluated. When one of the tonsillar fossa was cooled by isotonic fluid, the other has left untreated. Postoperative pain and mucosal healing pattern were assessed. Data were recorded and statistically analyzed. Healing process of the cooled down tonsillar fossae were significantly better on the 7th and 14th postoperative day (p < 0.01). Control tonsillar fossae had significantly higher pain scores on the 3rd, 7th and 14th postoperative day (p < 0.05). Administration of isotonic fluid, during thermal welding tonsillectomy for cooling tonsillar fossae, accelerates wound-healing process significantly and decreases tonsillectomy related pain complaints post-operatively.

The effect of intratympanic vitamin C administration on cisplatin-induced ototoxicity.

The objective of this study is to investigate the effect of intratympanic injection of vitamin C on cisplatin-induced ototoxicity. The study included 24 albino adult female rats (48 ears). The study animals were divided into four groups each of which was composed of six animals including a control (intraperitoneal cisplatin), a cisplatin-saline (saline intratympanic + intraperitoneal cisplatin), a C vit (intratympanic vitamin C) and a cisplatin-C vit group (intraperitoneal cisplatin + intratympanic vitamin C). As two animals had died due to cisplatin-induced ototoxicity (one in the control and one in the cisplatin-saline group) they were excluded from the study. The experiment was terminated, performing distortion product otoacoustic emission (DPOAE) measurement prior to procedures and at the end of the experiment. The results of the statistical analysis were evaluated. In the cisplatin-C vit group, there were no significant decreases in DPOAE amplitudes at 2 kHz (p > 0.05). Although a decrease was observed in DPOAE amplitudes at 2.8, 4, 6, and 8 kHz frequencies, these amplitude reductions were significantly lower than the control group (p < 0.05). Intratympanic vit C infusion provided a protective effect against cisplatin-induced ototoxicity primarily at 2 kHz and at other frequencies (2.8, 4, 6, and 8 kHz), and it did not produce a toxic effect in the cochlea.

Septorhinoplasty with spreader grafts enhances perceived voice quality without affecting acoustic characteristics.

OBJECTIVE: To identify the effect of septorhinoplasty with spreader grafts on patients' perception of voice and to measure formant frequencies that may be responsible for perceived changes in voice quality. METHODS: A total of 20 patients who underwent septorhinoplasty and had spreader grafts placed during the operations were included. All subjects were tested within the week before surgery and 1-3 months postoperatively by means of perceptual assessment (Voice Handicap Index-10 [VHI-10] and self-assessment of hypo/hypernasality), acoustic analysis, and formant frequency analysis. RESULTS: The mean of VHI-10 score was decreased from 9.44±6.1 to 5.1±3.94 postoperatively (P=0.03). Fifteen patients (75%) perceived their voices to be hyponasal before surgery, but only three perceived the hyponasality to persist after surgery (P<0.001). No patient perceived the voice to be hypernasal either before or after surgery. Fifteen patients (75%) perceived their overall voice quality to be improved, whereas five patients perceived no change. None of the patients perceived their voice to be worse after surgery. There were no significant differences between pre- and postoperative acoustic analysis and formant frequency analysis (P>0.05). CONCLUSION: Septorhinoplasty with spreader grafts significantly improved patients' perception of voice; however, acoustic analysis and formant frequency analysis of nasalized vowels did not reveal any significant differences after the operation.