Comparison of Vocal Outcomes Following Partial and Total Tonsillectomy in Pediatric Patients

Tonsillar hypertrophy can alter the vocal tract; however, the potential effects of partial and total tonsillectomy on pediatric voice characteristics have been relatively understudied compared to their impact on sleep-related problems and the management of tonsillitis. This study aimed to compare the effects of partial and total tonsillectomy on voice characteristics in pediatric patients over the first three postoperative months.

Forty-four children (4-12 years) undergoing total (n = 22) and partial (n = 22) tonsillectomy were evaluated preoperatively and at 1 and 3 months postoperatively. Voice outcomes were assessed using both subjective (Pediatric Voice Handicap Index [pVHI]) and objective measures, including Multi-Dimensional Voice Program parameters, cepstral analyses, and formant frequency evaluations.

Both groups demonstrated a significant reduction in pVHI scores (P < 0.001) and mean fundamental frequency (F0) values (P = 0.037 for total, P = 0.006 for partial tonsillectomy), while jitter, shimmer, noise-to-harmonic ratio, and cepstral measures showed no significant postoperative changes. Formant frequency shifts, particularly in F1 and F2 of /i/, were more pronounced after total tonsillectomy, indicating subtle resonance alterations.

Tonsillectomy influences vocal output by reducing vocal tract resistance and lowering F0, even without direct vocal fold involvement. Preoperative counseling is recommended, particularly for children or parents concerned about potential resonance changes, as total tonsillectomy may cause subtle alterations in vocal tract resonance despite the absence of direct vocal fold involvement.