Clinical assessment
Nasality was subjectively assessed by a Visual Analogue Scale (VAS) filled by the patients, and by questionnaires filled by their partners. The severity of abnormal nasality was reported using a 10-cm VAS. Higher scores reflect worse symptoms of abnormal nasality. A VAS score ≥ 3 was considered to indicate significant abnormal nasality. Abnormal nasality was also assessed by the patients’ partners using questionnaires. The questionnaire was “Do you think the patient had abnormal nasality in the last 3 months?” The answers included no abnormal nasality, mild abnormal nasality, and noticeable abnormal nasality.
The nasality was objectively assessed using nasalance scores with a nasometer. The Nasometer II system (model 6450, Kay Elemetrics Corp., Lincoln Park, NJ) was used in this study. The ratio of nasal acoustic energy to total (oral and nasal) acoustic energy was displayed with nasalance score as a percentage.13 The speech material included three vowels [a], [i], [u], and a nasal consonant [m]. Two repetitions, [MaMa] and [MiMi], were also used for evaluation. Two sentences in Chinese were developed for the nasometric evaluation in this study. The hypernasality sentence contained 5 nasal syllables, with 0% nasal consonants and 100% nasal vowels. The hyponasality sentence contained 5 nonnasal syllables, with 100% high-pressure consonants. The tests were evaluated twice, and the average nasalance scores were recorded. These scores, including subjective nasality evaluation and objective nasalance scores, were recorded before surgery. These scores were also evaluated at 6 and 12 months after surgery.