Abstract
Nasal surgeries including rhinoplasty, septoplasty, and turbinoplasty are among the most commonly performed otolaryngologic procedures worldwide, with millions of operations conducted annually. The nasal cavity functions as a critical resonator in the vocal tract, contributing to voice quality through complex acoustic coupling mechanisms. Alterations in nasal anatomy may theoretically modify vocal resonance characteristics, yet the clinical significance and comparative effects across different surgical procedures remain incompletely understood. This systematic review aimed to synthesize current evidence on acoustic voice changes following rhinoplasty, septoplasty, and turbinoplasty, comparing the magnitude and clinical relevance of alterations across procedure types. Following PRISMA 2020 guidelines, we conducted a comprehensive systematic search across six databases (PubMed MEDLINE, EMBASE, Scopus, Web of Science Core Collection, Cochrane CENTRAL, and Google Scholar) through December 2023. Eligible studies included prospective or retrospective investigations measuring objective acoustic parameters (nasalance, formant frequencies, fundamental frequency, voice quality indices) or subjective voice outcomes before and after nasal surgery in adult patients. Studies were stratified by surgical procedure type. Quality assessment employed modified Newcastle-Ottawa Scale criteria for observational studies. Random-effects meta-analysis was performed for septoplasty nasalance outcomes where sufficient data homogeneity existed. GRADE framework was applied to assess certainty of evidence. From 832 initial records, 676 unique studies underwent title/abstract screening, with 189 full-text articles assessed for eligibility. Forty-three studies met inclusion criteria (septoplasty: n=26, rhinoplasty: n=11, turbinoplasty: n=5, combined procedures: n=1), encompassing 2,039 patients. Meta-analysis of 12 septoplasty studies (N=600 patients) demonstrated a pooled mean increase in nasalance scores for nasal phonemes of 17.2 percentage points (95% CI: 15.0-19.4, p<0.001) with substantial heterogeneity (I²=66.1%). Subgroup analysis showed consistent effects across prospective (n=11 studies, 18.6 pp, 95% CI: 14.8-22.4) and retrospective (n=1 study, 11.2 pp, 95% CI: 8.4-14.0) study designs. Rhinoplasty investigations (n=399 patients) showed variable effects on formant frequencies F3-F5, with professional voice users exhibiting greater sensitivity to acoustic changes. Turbinoplasty studies (n=224 patients) revealed intermediate effects. Quality assessment identified 27 high-quality studies (63%), 16 moderate-quality (37%), and 0 low-quality (0%). GRADE assessment indicated very low certainty for septoplasty nasalance outcomes and low certainty for rhinoplasty and turbinoplasty outcomes. Funnel plot analysis and Egger's regression test (t=1.34, df=10, p=0.21) indicated no statistically significant funnel plot asymmetry. Trim-and-fill analysis imputed zero studies, leaving the pooled estimate unchanged; these analyses should be interpreted cautiously given the small number of studies and substantial heterogeneity. .Available observational evidence suggests that nasal surgery may be associated with measurable alterations in vocal resonance. Septoplasty was associated with increased nasalance (pooled increase 17.2 percentage points, 95% CI: 15.0-19.4), while rhinoplasty studies reported variable changes in higher formant frequencies and turbinoplasty studies reported intermediate acoustic effects. The clinical significance of these changes remains uncertain, and limited observational evidence suggests that professional voice users may be more sensitive to subtle acoustic alterations. Preoperative counseling should address potential voice changes, particularly for individuals with high vocal demands. Future research should employ standardized acoustic protocols and longer follow-up periods to better characterize recovery trajectories and identify patient subgroups at risk for clinically significant voice alterations.