pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

Tonsillectomy and Change in Voice

[A daughter seems to have had a change in her voice after her tonsillectomy and adenoidectomy.]

Since our daughter’s tonsillectomy and removal of her adenoids in May, she has had a very high pitch voice. Are we to assume that something may have gone wrong during the surgery and her vocal chords were impacted. What would cause her new high pitch voice?… Shelley F
Thanks for your perusal of my web site. I had no idea that my first tonsillectomy article would generate interest sufficient to require a second article and responses to so many varied, and specific questions. As you can tell from the articles, despite their clear indications and usefulness in many instances, tonsillectomies are not without their risks. They are NOT performed NOW with the almost knee-jerk, cavalierity that they once were.

You didn’t mention what the indications were for the adeno-tonsillectomy your daughter had, which limits my ability to assess the situation; however, it is not unheard of, or uncommon, to have some amount of change in vocal quality following an adenoidectomy (less so a tonsillectomy).

Additionally, I’m not sure what you mean when you use the term: “high pitched.” I did have a patient once who came to me complaining that her son’s speech always sounded “nasal” to her. He didn’t have any medical indication for the tonsillectomy (which her nurse-neighbor had told her she should obtain), and I told her so. We had a good enough relationship that, even after she had seen a local ENT on her own- and had her son go through the procedure, she returned to me for follow-up. Her son then had what she described as “a higher voice,” but, to me, it had changed very little, and mostly in quality (resonance). To her, he still sounded “stuffed up,” and it was true, he did have some nasal quality to his speech – which, if anything, an adenoidectomy would have made more pronounced.

Anatomically, the vocal chords are separated a distance from tonsilar tissue. One of the ways the procedure is performed is with a wire loop on the end of a trigger like mechanism. The loop is placed around the tissue and, when the trigger is pumped, it tightens, cutting through the tissues (like a wire cheese cutter). As you can guess there is a bit of bleeding which needs to be controlled with the laser. The surrounding tissues do contain vascular and neural tissues; but, the most prominent concern, when performing the procedure, is to avoid blood vessels in close proximity.

To INCREASE the pitch of one’s voice, the vocal chords need to be TIGHTENED. That is why when someone suffers nerve damage to the vocal chords they nearly always speak with a “lower” more “hoarse” voice- not “higher.” Your daughter speaking with a “higher” voice (in pitch) would presume that the chords had somehow gotten tighter. One would have to conjecture that there would have to be just the right amount of swelling (which theoretically should resolve) or some scar tissue formation which pulls in just the right way on the vocal chords (and which would take some time to initially form then could resolve with age as well.) One would think that both of those scenario’s would be unlikely; especially, without a more pronounced change in the “quality” of her voice (i.e. raspy, hoarse, etc).

If your observations persist over a few weeks, an ENT specialist can directly observe the vocal chords with a scope to see if there has been any damage; BUT, that is yet another procedure.

One of the things you might do, to try and delineate the issue further in your mind, is to play a singing game with her (if she is old enough to sing.) You can have her try and match your “Me, My, MEE, MOO- I Love You TOO” at various pitch levels to see if she has trouble matching, or any difficulty with lower notes.

In short, I would be surprised, with the symptoms you describe, that there has been any permanent damage to the chords. If they continue to concern you, ask your Pediatrician what he/she thinks. If he needs, he could refer you to a trusted Pediatric ENT to evaluate her chords directly.

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