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.