Voice and Resonance After Rhinoplasty: Research and Planning

Author: Op. Dr. Javidan Asafov · ENT / Otolaryngology Specialist · Last medical review: 25.10.2026

The voice’s journey: from the vocal folds to the nose

When you speak or sing, air from the lungs sets the two vocal folds (vocal cords) in the voice box (larynx) vibrating. How fast the vocal folds vibrate determines the pitch of the voice, that is, how high or deep it sounds. This vibration, in turn, is determined by the length, tension and mass of the vocal folds; this is why operations to raise or lower the voice are aimed at the vocal folds or the cartilages of the larynx (voice pitch surgery).

On its own, the sound produced at the vocal folds is rather like a plain buzz. As this sound passes through the vocal tract, made up of the throat, mouth and nasal cavities, some frequencies are strengthened and others are weakened. Just as the same note sounds different on a guitar and on a violin, the shape and volume of these cavities give the voice its own individual colour. This is called resonance, and the frequency bands that are strengthened in the vocal tract are called formants.

The nose is part of this resonance system, but it does not play the same role in every sound. For most sounds, the soft palate rises and closes off the back of the nose, and the sound comes out through the mouth. In nasal consonants such as “m” and “n”, however, the soft palate lowers, and sound and air also pass through the nose. The vowels next to these sounds also resonate through the nose to some extent. This is why changes in the nose are heard especially in m and n sounds and in words that contain them. The nose does not produce the voice; it contributes to its colour.

Two different kinds of “talking through the nose”

What is called “talking through the nose” in everyday language can actually describe two different conditions that are the opposite of each other:

• Blocked-nose voice (hyponasality): When the nose is blocked, the sound that should pass through the nose in m and n sounds cannot get through. The voice sounds muffled, as if you have a cold, and “my nose” sounds like “by dose”. A deviated septum, enlarged turbinates, allergy and the swelling of the first weeks after surgery can cause this.
• Too much nasal resonance (hypernasality): When the soft palate cannot close off the back of the nose well enough, sounds that should not pass through the nose also resonate through it. This is seen mostly in problems of the palate and the back of the nose, such as cleft palate. Because rhinoplasty does not touch the soft palate, this kind of problem is not expected.

“Nasalance”, which is often used in research, is a measurement that shows what proportion of the total sound energy coming from the nose and mouth during speech comes from the nose. When the nasal airway is opened, nasal resonance and nasalance in nasal sounds may increase somewhat; this is different from hypernasality, which is caused by the soft palate not closing properly. When the nose is narrowed or blocked, on the other hand, nasalance decreases.

What does the research show?

The effect of nasal surgery on the voice has been studied using computer analysis of voice recordings (acoustic analysis), devices that measure nasalance (nasometers), assessments by trained listeners and voice questionnaires completed by patients. Most of these studies were carried out with small numbers of patients, and their methods differ from one another, so the results need to be interpreted with caution.

In a systematic review that brought together studies covering sinus surgery, septoplasty, turbinate reduction and rhinoplasty, a significant increase in nasalance was seen in the first month after surgery, and this difference had disappeared in the measurements at 6 months. No significant change was found in the other measurements that reflect the pitch and quality of the voice; in five of the nine studies that examined how patients perceived their voice, most patients reported that they did not notice any change in their voice. Most of the studies in this review were on sinus and septal surgery; data on rhinoplasty are limited. A more recent systematic review also stated that measurable changes in vocal resonance can occur after nasal surgery: after septoplasty, nasal resonance in nasal sounds increased, while rhinoplasty studies reported variable results for some measurements related to tone. The authors emphasised that the level of evidence is low and that the importance of these changes in daily life remains unclear; they noted that professional voice users may be more sensitive to small differences and that possible voice changes should be discussed with them before surgery.

The results of studies that focus only on rhinoplasty differ from one another. In a study of 27 people who had rhinoplasty, trained listeners noticed 5 months after surgery that the voice sounded more blocked, changes were found in the acoustic features of m and n sounds, and the patients’ voice questionnaire scores worsened. The researchers attributed this to narrowing of the nasal cavity; they recommended discussing this possibility before surgery with people who use their voice professionally and considering a more limited (conservative) surgical plan. In another study of 30 people who use their voice professionally, however, no significant change was found in nasalance or in voice questionnaire scores after rhinoplasty, and the changes were reported not to be a problem for these people. In a small study of 18 opera singers, too, the pitch of the voice had not changed 6 months after surgery, and the singers generally rated the effect of the operation on their voices positively.

The overall picture is this: measurable changes in the voice can occur after nasal surgery, and they are mostly small. The blocked quality of the first weeks lessens with healing; the increase in nasal resonance measured in the first month also tends to lessen over time in studies. Because the volume of the inside of the nose changes in rhinoplasty, it is also possible for a small difference in tone to be lasting. Many people do not notice this; those who use their voice professionally, however, may be more sensitive.

When the nasal airway is opened: septum and turbinates

Rhinoplasty is often combined with straightening a deviated septum (septoplasty) and reducing enlarged turbinates (turbinate reduction). The aim of these procedures is to open the airway. In people whose nose has been blocked for a long time, the voice may have sounded slightly “blocked” for years; because the person has got used to it, they may not even be aware of it. When the airway is opened, some people notice that their voice sounds clearer and comes out more easily. In a study of 20 people who had septorhinoplasty with cartilage grafts that support the nasal valve, most patients who had found their voice blocked before surgery reported that this complaint had improved after surgery; acoustic measurements, however, showed no significant difference.

Septoplasty does not change the outward appearance of the nose and does not touch the larynx; its effect on the voice is limited to tone, and changes in the measurements usually lessen within months. Reducing the turbinates while preserving their function, rather than removing them completely, is also important so that the nose can keep humidifying and warming the air.

The nasal valve and making the nose smaller

The narrow area in the middle part of the nose, between the septum and the upper lateral cartilages, is called the nasal valve (internal nasal valve). This area, one of the narrow points inside the nose, has a significant effect on airflow when you breathe in. Removing a hump or making the nose noticeably smaller can narrow this area if appropriate supports are not used. When the valve narrows, breathing can become harder, and the nose’s contribution to resonance may also change.

This is why rhinoplasty planning aims not only at appearance but also at preserving the airway. At the examination the inside of the nose is assessed endoscopically; when needed, cartilage grafts that support the nasal valve can be used in the same operation (rhinoplasty surgery and recovery). For people who use their voice professionally, discussing this before surgery helps to set expectations correctly.

The first weeks after surgery

In the first days, swelling and crusts inside the nose block it. If silicone packs were placed inside the nose, they are usually removed within 2–5 days; in many patients no packing is used at all. During this time the voice sounds clearly blocked, and you may hear your own voice inside your head as more muffled and different. This is expected.

Once any packs have been removed, and with regular nasal care, breathing and the voice gradually open up. Swelling eases noticeably from week 3 and most of it settles within the first 2 months; the blocked quality of the voice lessens along with this process. Fine swelling at the nasal tip can last up to 12 months. To judge your voice, waiting for the period when most of the swelling has settled, rather than the first weeks, gives a fairer comparison.

The following help during this period:

• Nasal care: When the nasal rinsing and moisturising your surgeon recommends are done regularly, crusts decrease and breathing becomes easier.
• Drink enough water: Breathing through the mouth while the nose is blocked dries the throat and the vocal folds; drinking enough water during the day brings relief.
• Do not blow your nose hard, and do not keep clearing your throat: Blowing the nose hard is not recommended. Constantly clearing your throat because of secretions reaching it also irritates the vocal folds; swallowing or taking a sip of water instead helps.
• Do not strain your voice: Because you hear your own voice differently while your nose is blocked, you may speak more loudly without realising it. Avoid shouting, speaking loudly for long periods and whispering.

Anaesthesia, the breathing tube and the throat

Rhinoplasty is performed under general anaesthesia and usually takes 1.5–3 hours. During the operation, a breathing tube placed through the mouth or a similar airway device is usually used to keep the airway secure. When a breathing tube is used, it passes between the vocal folds and is placed in the windpipe (trachea).

This is why some patients may have a sore throat, a burning feeling, dryness or mild hoarseness after surgery. A sore throat after surgery is a common complaint after general anaesthesia and usually eases gradually over the first days and clears up on its own. Dryness from breathing through the mouth can make this feeling worse; warm drinks and drinking enough water bring relief. Which medicines to use is decided on your surgeon’s advice.

Long-lasting vocal fold problems related to the breathing tube are rare. A clinical practice guideline on hoarseness lists recent use of a breathing tube and professional use of the voice among the situations that may call for the larynx to be assessed without waiting. This is why, if your hoarseness is not improving after surgery or is getting worse, mention it at your follow-up visit without waiting for 3 weeks to pass; hoarseness lasting longer than 3 weeks should always be assessed with an endoscopic examination of the larynx (hoarseness). If you use your voice professionally, also mention any changes you notice in your voice at your follow-up visits.

Planning for people who use their voice professionally

For singers, imams, hafizes (people who have memorised the Qur’an), muezzins, actors, teachers, presenters, broadcasters and call-centre workers, the voice is not only a means of communication but also a working tool. For these people, too, voice changes after rhinoplasty are mostly small and the blocked quality of the first weeks is temporary; however, because even small differences in tone may be noticed, it helps to pay attention to a few points in planning.

• Tell your surgeon: At your first consultation, describe how and how much you use your voice, your voice type and your upcoming commitments. Preserving the airway, the nasal valve and the structures inside the nose is an important part of planning for these patients; possible voice changes and your expectations are discussed openly before surgery.
• Choose the timing carefully: Plan the operation for a time away from periods when you will use your voice heavily, such as important concerts, recordings and tours, the month of Ramadan and tarawih prayers, or the first weeks of the school year. Since most of the swelling settles within the first 2 months, it helps not to schedule a performance in which the tone of your voice matters in the weeks right after surgery.
• A gradual return: In the first weeks after surgery, activities that raise your heart rate and involve straining are avoided; singing loudly and for long periods, and recitations that need a powerful voice, such as the call to prayer (adhan) and Qur’an recitation (tilawah), are also postponed during this time. Starting with a light speaking voice and building the voice up gradually is a general approach. Your surgeon decides at your follow-up visits, according to your healing, when you can return to singing, long recitation or the stage.
• Vocal warm-up: The light vocal warm-up exercises familiar to singers and heavy voice users are a general habit that helps the voice start without strain. After surgery, these too are resumed gradually, without straining the voice.
• Give yourself time: It is natural to hear your own voice differently while your nose is blocked and the swelling persists. Waiting for most of the swelling to settle before judging your voice prevents unnecessary worry.

Recording your voice before surgery

Many people who use their voice professionally record their own voice before surgery. This makes it easier to answer the question “has my voice changed?” not just by feel but by comparison. For the recording to be useful:

• The same conditions: Record in the same room, with the same phone or microphone and at the same distance from your mouth.
• The same content: You can record a sustained “ah” sound, a few sentences with plenty of m and n sounds (for example, “My mum’s mint and lemon lemonade smells amazing.”) and a song you always sing or a passage you always recite.
• Compare at the right time: Recordings made in the first weeks naturally sound more blocked because of the swelling; for comparison, it is more meaningful to wait for the period when most of the swelling has settled.

When we speak, we hear our own voice not only through the air but also through the vibration of the bones of the skull. This is why everyone finds their voice on a recording a little unfamiliar. Always comparing one recording with another reduces misleading impressions.

When should your voice be checked?

In the first weeks after surgery, a blocked voice, nasal congestion and a dry throat are expected parts of healing. Follow-up visits are planned at 1 week, 2 weeks and 1 month; sharing your observations about your voice at these visits makes it easier to assess your healing. Mention the following at your follow-up visit:

• Hoarseness that does not improve: If your hoarseness is not easing after the first days or is getting worse. If your voice is clearly breathy and weak, or if you often cough when drinking water, let us know without waiting for your follow-up day. Hoarseness lasting longer than 3 weeks should always be assessed (hoarseness).
• Voice fatigue and strain: Your voice tiring or cracking after speaking or reciting for a short time, or difficulty reaching your usual notes.
• Difficulty breathing: Nasal blockage that continues even after the swelling has settled, or that remains marked on one side.

If you develop sudden shortness of breath, noisy or wheezy breathing, or difficulty swallowing, contact us without delay, without waiting for your follow-up visit.

Frequently asked questions

Will my voice become higher or deeper after rhinoplasty? This is not expected. How high or deep the voice is, that is, its pitch, is determined by the vocal folds in the larynx; rhinoplasty does not touch the vocal folds. Studies have found no meaningful change in the pitch of the voice after nasal surgery. Changes inside the nose, on the other hand, can create small differences in the tone of the voice, especially in m and n sounds. Changing the pitch of the voice is possible with separate operations performed on the vocal folds (voice pitch surgery).

When can I go back to singing? This depends on the procedures performed, your healing and how heavily you use your voice; this is why there is no single number of days that applies to everyone. Because avoiding strain is recommended in the early period, powerful and prolonged singing is postponed during this time. Starting with light, short attempts and building the voice up gradually is a general approach. Your surgeon decides at your follow-up visits when and at what intensity you can return; the individual instructions you are given take priority.

Does the “talking through the nose” after surgery go away? Usually it does. The blocked voice of the first weeks comes from swelling inside the nose, crusts and any packs. Swelling eases noticeably from week 3 and most of it settles within the first 2 months; the voice opens up along with this process. If the nasal airway was widened, m and n sounds may resonate through the nose a little more in the first months; in studies, this increase has tended to lessen over time. It is also possible for a small difference in tone to be lasting; many people do not notice it. If nasal blockage and a blocked voice continue even after the swelling has settled, this is assessed at an examination.

I am a hafiz; will my Qur’an recitation be affected? In tajweed, bringing the sound of the letters nun and mim through the nose is called ghunnah; this is directly related to the nose’s contribution to the voice. This is why, in the first weeks while the nose is blocked, recitation with ghunnah may sound blocked and muffled; as the swelling settles, this blocked quality lessens too. Because rhinoplasty does not touch the larynx or the vocal folds, a change in the pitch of the voice is not expected; however, because ghunnah depends on nasal resonance, reciters with a trained ear may notice small changes in tone. It is helpful to discuss possible changes before surgery and to record your recitation. Planning the operation away from periods of intensive recitation, such as Ramadan and tarawih, and returning to recitation gradually make the process easier. If you are in hifz training (memorising the Qur’an) or have an intensive recitation programme, mention this at your examination.

Does septum surgery change the voice? Septoplasty is performed from inside the nose, does not change the outward appearance of the nose and does not touch the larynx. Because the nasal airway is opened, nasal resonance in m and n sounds may increase somewhat; in one review, this increase was clear in the first month, while no significant difference remained in the measurements at 6 months. Some people whose nose has been blocked for a long time, on the other hand, notice after surgery that their voice sounds clearer and comes out more easily (deviated septum).

Does it make sense to record my voice before surgery? Yes. Many people, especially those who use their voice professionally, record their voice before surgery. Recording in the same room, with the same device and with the same content (for example, a few sentences with m and n sounds and a piece you always sing) makes comparison easier later. For comparison, it is more meaningful to wait for the period when most of the swelling has settled rather than the first weeks.

This article is for general information; please consult your physician for diagnosis and treatment.