We have received numerous questions about the effects of nasal surgery on the voice. Is such surgery beneficial? Does the voice change? Should nasal surgery be performed in the hopes of improving resonance?
Functional surgery on the nose normally involves the nasal septum or the nasal turbinates. The septum is a thin plate of cartilage and bone which separates the two nasal passages. It is ideally perpendicular, a flat plate which arises along the floor of the nose and rises to the top, running from the tip of the nose to the back. You can grasp your septum by placing your thumb and forefinger in the two nostrils.
Ideally, the septum is in midline. In many cases, however, it is deviated, off-center. As it runs from the front to the back, it can buckle to one side, or be S-shaped, and protrude into both nasal passages. It can be partly dislocated along the floor of the nose. If the deviation is marked, the septum can cause nasal obstruction on either (or both) sides.
The nasal cavities are also occupied by turbinates, shelves of tissue that project from the outer walls into the passage. These turbinates warm and humidify the air. If the turbinates become enlarged, they can further decrease air flow through the nose. If the septum is deviated to one side, quite often the turbinate on the roomier (concave) side enlarges to fill up the excess space.
What are the symptoms of deviated septum or enlarged turbinates? They may include: nasal obstruction, postnasal drip, snoring, sleep apnea, recurrent ear blockage, facial pain, recurrent sinusitis, and recurrent nose bleeds. Singers additionally complain of decreased nasal resonance.
The issue of nasal resonance should be discussed. Although there is a physical sensation of resonance over the mask, acoustically the nose normally plays only a minor role in shaping the voice. Since good vocal technique involves a raised palate, air normally does not flow through the nose during singing. The air in the nose resonates more by transmission of vibration through the hard palate and adjacent facial bones. Therefore, although the sensation of sound around the nose is strong, the acoustic effect on the voice emerging from the mouth is less significant.
By way of treatment, it is important to understand that a number of medical treatments exist for nasal obstruction. Don’t be rushed into surgery unless: (1) Medical therapy has been exhausted, and (2) There is a clear correlation between your symptoms and physical findings in the nose. If surgery is presented as the first and only option, consider a second opinion.
If, however, other treatments have not been successful, your symptoms are significantly bothersome, and physical findings explain your symptoms, you should consider surgery. Visualization of the blockage with an endoscopic photograph can be helpful in understanding which surgery may be indicated.
Septal surgery (septoplasty) consists of repositioning the septum in the midline of the nose, thereby maximally opening both nasal passages. This is a functional (not a cosmetic) operation which is performed through the nostrils. Sutures are placed inside the nostrils, and not outwardly visible. There is no change in the outward appearance of the nose postoperatively.
In some cases, it may be necessary to reduce the prominence of the turbinates, either as part of the septoplasty, or as a separate procedure. This is normally done by displacing the turbinate to the side, or by reducing its bulk using electrocautery or laser. If necessary, part of the turbinates can be surgically excised. Care must be taken, however, not to remove too much turbinate tissue, since this can lead to excessive nasal drying and crusting. It is better to have a minor turbinate procedure repeated than to be overly enthusiastic in tissue removal.
How does septal or turbinate surgery affect the voice? As mentioned above, the sensation of sound in the mask may change. Some singers feel that their voice is clearer or more resonant. Since each case is different, it is difficult to generalize. I would however caution against having septal surgery done merely to “improve” the voice. A detailed evaluation with your teacher and a sympathetic otolaryngologist is the best starting point if you are considering these procedures.
