Voice Change After Adenotonsillectomy in Children: A Systematic Review and Meta-Analysis

Objective: Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy.Data sources: The PubMed, Medline, EMBASE, and Cochrane databases.Review methods: The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire.Results: Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery.Conclusions: This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery