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Kumar A, Dhar A, Srivastava A, Kumar R. A Prospective Comparative Analysis to Study the Impact on Voice Changes Following Endoscopic Thyroidectomy. Surg Laparosc Endosc Percutan Tech 2024; 34:407-412. [PMID: 38949300 DOI: 10.1097/sle.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/16/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Endoscopic approach has come up as a safe and feasible procedure for thyroidectomy with better cosmetic outcomes. However, concerns over its safety in terms of nerve injury and postoperative voice changes remain. This prospective study evaluated the role of vocal cord function assessment using laryngeal examination and voice analysis in patients who underwent endoscopic hemithyroidectomy either by the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) or the bilateral axillobreast approach (BABA). METHODS Thirty-nine consecutive patients were randomly allocated to either of the 2 groups of endoscopic hemithyroidectomy; 19 in TOETVA and 20 in the BABA groups. Vocal cord function was assessed subjectively using the GRBAS scale and objectively by acoustic analysis of parameters such as jitter, shimmer, mean frequency (F 0 ), noise-to-harmonic ratio (NHR), and maximum phonatory time (MPT) at baseline, postoperative day 10, and 3 months after surgery. RESULTS There were no significant differences in mean GRBAS scores and values of mean frequency, jitter and shimmer between the 2 groups and on postoperative day 10 and at 3 months compared with baseline. The mean NHR and MPT showed no differences between the 2 procedures. However, there was a significant decrease in their values on day 10 postsurgery, compared with baseline. These values returned to their baseline at 3 months. The other operative parameters were comparable between the 2 groups, except for the shorter mean operative time in the TOETVA group. CONCLUSIONS Perioperative quantitative voice parameters were comparable with no statistically significant difference between the 2 techniques of endoscopic thyroidectomy.
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Affiliation(s)
| | | | | | - Rakesh Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
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Paspala A, Dimitriou E, Delides A, Stamelos M, Peppa M, Nastos C. Translation and Cross-Cultural Adaptation of the Thyroidectomy-Related Voice Questionnaire (TVSQ) in Greek Population. J Voice 2024:S0892-1997(24)00179-6. [PMID: 39025752 DOI: 10.1016/j.jvoice.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVES The Thyroidectomy-Related Voice Questionnaire (TVSQ) is a useful tool in the detection of voice changes and dysfunctions and the diagnosis of other symptoms related to transient or permanent laryngeal nerve damage in patients after thyroidectomy. The aim of our study is the translation and validation of (TVSQ) in the Greek language and in Greek population for the first time. METHODS The TVSQ was translated from English to Greek and vice versa by two independent researchers, while before the application of the TVSQ in clinical practice, a control group of 20 people was used. The following methods were used for the weighting and analysis of the TVSQ: Polychoric correlation, Cronbach's alpha, confirmatory factor analysis, and item response theory (IRT). RESULTS Polychoric correlations revealed that questions 1-10 have a strong positive correlation with each other, while the correlation of the rest of the TVSQ items is positive. Subsequently, for the first subgroup of questions ("voice change") Cronbach's alpha was equal to 0.950, while for the second ("throat and neck discomfort") Cronbach's alpha was equal to 0.846. Thus, we conclude that the internal consistency reliability is high for both subgroups of TVSQ questions. With the IRT method we showed that for the first subgroup of questions ("voice change"), the item with the least predictive value is question 5, while for the second subgroup of questions ("throat and neck discomfort"), the item with the least educational value was question 15. CONCLUSIONS Our team translated and validated the TVSQ with the above statistical methods in the Greek language, so that it can be used as a valuable tool in clinical practice, and more specifically in patients undergoing thyroidectomy. TVSQ can play a significant role on the diagnosis of either postoperative voice disorders and other symptoms related to thyroidectomy.
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Affiliation(s)
- Anna Paspala
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; ENT Department, Attikon University Hospital, Athens, Greece.
| | - Evangelos Dimitriou
- Department of Statistical Science, University College London, London, United Kingdom
| | | | | | - Melpomeni Peppa
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine & Research Institute, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Constantinos Nastos
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece; ENT Department, Attikon University Hospital, Athens, Greece
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Cai H, Ternström S, Chaffanjon P, Henrich Bernardoni N. Effects on Voice Quality of Thyroidectomy: A Qualitative and Quantitative Study Using Voice Maps. J Voice 2024:S0892-1997(24)00082-1. [PMID: 38714436 DOI: 10.1016/j.jvoice.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 05/09/2024]
Abstract
OBJECTIVES This study aims to explore the effects of thyroidectomy-a surgical intervention involving the removal of the thyroid gland-on voice quality, as represented by acoustic and electroglottographic measures. Given the thyroid gland's proximity to the inferior and superior laryngeal nerves, thyroidectomy carries a potential risk of affecting vocal function. While earlier studies have documented effects on the voice range, few studies have looked at voice quality after thyroidectomy. Since voice quality effects could manifest in many ways, that a priori are unknown, we wish to apply an exploratory approach that collects many data points from several metrics. METHODS A voice-mapping analysis paradigm was applied retrospectively on a corpus of spoken and sung sentences produced by patients who had thyroid surgery. Voice quality changes were assessed objectively for 57 patients prior to surgery and 2months after surgery, by making comparative voice maps, pre- and post-intervention, of six acoustic and electroglottographic (EGG) metrics. RESULTS After thyroidectomy, statistically significant changes consistent with a worsening of voice quality were observed in most metrics. For all individual metrics, however, the effect sizes were too small to be clinically relevant. Statistical clustering of the metrics helped to clarify the nature of these changes. While partial thyroidectomy demonstrated greater uniformity than did total thyroidectomy, the type of perioperative damage had no discernible impact on voice quality. CONCLUSIONS Changes in voice quality after thyroidectomy were related mostly to increased phonatory instability in both the acoustic and EGG metrics. Clustered voice metrics exhibited a higher correlation to voice complaints than did individual voice metrics.
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Affiliation(s)
- Huanchen Cai
- Division of Speech, Music and Hearing, KTH Royal Institute of Technology, Stockholm, Sweden.
| | - Sten Ternström
- Division of Speech, Music and Hearing, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Philippe Chaffanjon
- University of Grenoble Alpes, CNRS, Grenoble INP, GIPSA-lab, Grenoble, France; Medical School, Université Grenoble Alpes, Grenoble, France
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Kim S, Kim KW, Hong YT. Phonetic features of patients with transoral endoscopic thyroidectomy. Auris Nasus Larynx 2023:S0385-8146(22)00237-1. [PMID: 36621450 DOI: 10.1016/j.anl.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The objective of this study was to compare phonetic outcomes of TOETVA with those of conventional transcervical thyroidectomy(OPEN). METHODS Retrospective chart review of total 61 patients who received thyroidectomy through OPEN (n = 34) or TOETVA (n = 27) approach in single tertiary center were enrolled. RESULTS There were significant differences in F0 between the two groups and there were significant changes from different time points within each group in jitter for vowel /i/. Aerodynamically, there were significant differences in mean sound pressure level for vowel /a/ and mean sound pressure level, mean air pressure, and aerodynamic resistance for syllable /pa/ between the two groups. In subjective VHI evaluations, there were no significant differences between the two groups. CONCLUSION This study is significant in that it has investigated voices of patients with TOETVA. Results of this study are expected to be useful for voice evaluation, treatment, and prevention in the future. LEVEL OF EVIDENCE: 3
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Affiliation(s)
- Sol Kim
- Department of Otolaryngology-HNS, Jeonbuk National University Medical School, Jeonju, Korea; Department of Research Institute for Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk, 560-182, Korea
| | - Ki Wook Kim
- Department of Rehabilitation, Jeonbuk National University Medical School, Jeonju, Korea; Department of Research Institute for Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk, 560-182, Korea
| | - Yong Tae Hong
- Department of Otolaryngology-HNS, Jeonbuk National University Medical School, Jeonju, Korea; Department of Research Institute for Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonbuk, 560-182, Korea.
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Nam IC, Bae JS, Lee SH, Kim JS, Hwang YS, Shim MR, Kim GJ, Park JO, Park YH, Sun DI. Prospective voice assessment after uncomplicated thyroidectomy: A comprehensive analysis of a single centre experience. Clin Otolaryngol 2023; 48:39-49. [PMID: 36268608 DOI: 10.1111/coa.13995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/05/2022] [Accepted: 10/01/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Voice change after uncomplicated thyroidectomy has been an important issue in the field of thyroid surgery. The aim of this study was to promote understanding of voice change after uncomplicated thyroidectomy by analysing the results for a large number of patients from a single institute. DESIGN We retrospectively reviewed the medical records of 2879 consecutive patients who underwent thyroidectomy and voice evaluation between January 2014 and December 2019 in a single institute. All the patients had their vocal status assessed using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) scores preoperatively and at 1, 3, and 6 months postoperatively. We analysed the pattern of voice changes over time and differences in voice parameters based on clinical factors. To confirm the usefulness of the TVSQ, the correlation between TVSQ scores and objective parameters was analysed. Lastly, predictive factors for persistent voice symptoms were analysed. SETTING Tertiary referral hospital. RESULTS The frequency ranges and TVSQ scores exhibited significant deterioration until 6 months following surgery. Among clinical factors, the extents of thyroidectomy and neck dissection were associated with worse voice parameters. The TVSQ score was significantly correlated with objective voice parameters. The extents of thyroidectomy and neck dissection were predictive of persistent voice symptoms at 6 months after thyroidectomy. CONCLUSION After uncomplicated thyroidectomy, most voice parameters tended to recover, but some parameters remained aggravated even at 6 months after surgery. With more extensive surgery, worse voice quality and the higher risk of persistent voice symptoms may be anticipated.
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Affiliation(s)
- Inn-Chul Nam
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ja-Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - So-Hee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jeong-Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yeon-Shin Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mi-Ran Shim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Hak Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Liu P, Yan J, Yang H, Yang Y. Evaluation of voice function after BABA robotic thyroid lobectomy: A comparative analysis with endoscopic thyroid lobectomy. Medicine (Baltimore) 2022; 101:e32321. [PMID: 36550846 PMCID: PMC9771197 DOI: 10.1097/md.0000000000032321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The purpose of this study was to compare the effect of robotic thyroid lobectomy via Bilateral Axlio-Breast Approach (BABA) and endoscopic thyroid lobectomy on the voice function. A total of 125 patients with thyroid cancer from March 2021 to July 2022 were divided into the robotic thyroid lobectomy group and the endoscopic thyroid lobectomy group. Acoustic index and voice handicap index (VHI-10) were compared between the 2 groups before and after (1 week, 1 month, 3 month) the surgery. In the robotic group, VHI-10 score was not significantly different before and after the surgery. In the endoscopic group, VHI-10 score after the surgery was significantly higher than that before the surgery. In the endoscopic group, the fundamental frequency (F0) declined significantly 1 week and 1 month after the surgery compared with that before the surgery. One week after surgery, F0 in the endoscopic group was (197.91 ± 24.15) Hz, which was significantly lower than that (206.77 ± 20.13) Hz in the robotic group. In the robotic group, there was no obvious decline in F0 and MPT in each follow-up period after surgery compared with those before surgery. In the endoscopic group, MPT declined significantly 1 week after the surgery compared with that before surgery. One week after surgery, MPT in the endoscopic group was (13.02 ± 9.28) s, which was significantly lower than that (17.55 ± 9.25) s in the robotic groups. There were no significant differences in Shimmer, Jitter, DSI and NHR during all postoperative follow-up periods compared with those before surgery in both groups. The voice function of robotic thyroid lobectomy via BABA is superior to endoscopic thyroid lobectomy.
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Affiliation(s)
- Peigen Liu
- Department of General Surgery, Panzhihua Central Hospital, Panzhihua, China
| | - Jing Yan
- Department of General Surgery, Panzhihua Central Hospital, Panzhihua, China
| | - Huaxiang Yang
- Department of Gastroenterology and Hepatology, Beijing You’an Hospital Affiliated to Capital Medicine University, Beijing, China
| | - Yinghong Yang
- Department of General Surgery, Panzhihua Central Hospital, Panzhihua, China
- * Correspondence: Yinghong Yang, Department of General Surgery, Panzhihua Central Hospital, Panzhihua 617000, China (e-mail: )
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Efficacy of laryngeal mask airway against postoperative pharyngolaryngeal complications following thyroid surgery: a systematic review and meta-analysis of randomized controlled studies. Sci Rep 2022; 12:18210. [PMID: 36307459 PMCID: PMC9616911 DOI: 10.1038/s41598-022-21989-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 10/07/2022] [Indexed: 12/31/2022] Open
Abstract
This meta-analysis aimed at investigating the effectiveness of laryngeal mask airway (LMA) against postoperative pharyngolaryngeal complications after thyroidectomy. MEDLINE, Cochrane Library, google scholar, and EMBASE databases were searched from inception through February, 2021, for randomized controlled trials (RCTs) comparing the incidence of pharyngolaryngeal complications following the use of LMA or endotracheal tube (ETT). Pooled results from seven RCTs involving 600 patients showed an association of LMA with a reduced risk of postoperative sore throat (POST) at 24 h [risk ratio (RR) 0.75, p = 0.006, four trials], but not at 1 h and 48 h after thyroidectomy. POST severity and hoarseness risk were lower in the LMA group than the ETT group at 1 h, 24 h, and 48 h (all p < 0.05). Nevertheless, hoarseness severity was lower in the LMA group only at postsurgical 48 h [standardized mean difference = - 0.35, p = 0.008, three trials]. Moreover, the risk of emergence cough was lower in patients using LMA than those receiving ETT (RR = 0.14, p = 0.002, two trials). The two groups did not differ in the severity of dysphagia at postoperative 1 h, 24 h, and 48 h. This meta-analysis showed that LMA may be associated with fewer pharyngolaryngeal complications compared to ETT without airway impacts. The limited number of included studies warrants further research to support our findings.
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Rovó L, Matievics V, Sztanó B, Szakács L, Pálinkó D, Wootten CT, Pfiszterer P, Tóbiás Z, Bach Á. Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy. Eur Arch Otorhinolaryngol 2021; 279:1995-2002. [PMID: 34854971 PMCID: PMC8930937 DOI: 10.1007/s00405-021-07199-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.
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Affiliation(s)
- László Rovó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Vera Matievics
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Balázs Sztanó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - László Szakács
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Dóra Pálinkó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Péter Pfiszterer
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Zoltán Tóbiás
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Ádám Bach
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary.
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Marchese MR, Galli J, D'Alatri L, D'Amore A, Sionne F, Trozzi L, Paludetti G, Bellantone R, Lombardi CP. Neck complaints before and after uncomplicated thyroidectomy: prevalence, postoperative outcome and relationships with thyroid weight and reflux like symptoms. Endocrine 2021; 73:98-106. [PMID: 33405016 PMCID: PMC8211607 DOI: 10.1007/s12020-020-02568-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The surgical thyroid disease includes upper aerodigestive complaints with not homogenous prevalence and specific features. The purpose was to analyze before and after total thyroidectomy (TT) the prevalence and severity of voice, swallowing, respiratory, and reflux airway symptoms in relation with thyroid weight. METHODS A total of 98 consenting patients undergoing TT were enrolled. Preoperatively, 1 and 3 months after TT, patients underwent videolaryngoscopy, subjective evaluation of voice (VIS), swallowing (SIS and EAT-10), respiratory (mMRC), and reflux symptoms (RSI, Gerd-Q). The scores were analyzed based on thyroid weight (<25 gr, 26-50 gr, 51-75 gr, >75 gr) and post-operative score gain was calculated from the score before TT and the follow-up examination. RESULTS In total, 40/98 selected cases of uncomplicated TT completed the postoperative evaluation. Endoscopic signs suggestive of reflux disease were observed in 1/40 (2.5%) and 0/19 cases before and after TT respectively. The prevalence of cases with abnormal reflux symptom index decreased significantly after surgery (8/40 vs 1/40) (p < 0.05), similarly occurred for the Gerd-Q (4/40 vs 1/40) (p < 0.05). Three months after TT the voice, swallowing and respiratory scores were significantly lower than the preoperative ones (p < 0.05). The SIS correlated positively with EAT-10 and RSI. After 3 months the postoperative score gain of voice, swallowing, respiratory, and reflux symptoms (Gerd-Q) was statistically higher (p < 0.05) in the cases with heaviest gland. CONCLUSIONS The surgical thyroid disease is associated to mild aerodigestive preoperative compressive symptoms, that include respiratory abnormalities and reflux like symptoms, regardless of the gland weight. In absence of endoscopic signs of airway reflux the presence of reflux symptoms suggests an overlapping with thyroid neck complaints. The patients undergoing uncomplicated TT had improvement in compressive symptoms and the greatest improvement is seen in larger goiters.
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Affiliation(s)
- Maria Raffaella Marchese
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC di Otorinolaringoiatria, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Jacopo Galli
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC di Otorinolaringoiatria, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Lucia D'Alatri
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC di Otorinolaringoiatria, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Annamaria D'Amore
- Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Division of Endocrine Surgery, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Francesco Sionne
- Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Division of Endocrine Surgery, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Lucrezia Trozzi
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC di Otorinolaringoiatria, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Gaetano Paludetti
- Department of Aging, Neuroscience, Orthopedics and Head and Neck Sciences, UOC di Otorinolaringoiatria, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Rocco Bellantone
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Division of Endocrine Surgery, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
| | - Celestino Pio Lombardi
- Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Gastroenterologic, Endocrine-Metabolic and Nephro-Urologic Sciences, Division of Endocrine Surgery, "Fondazione Policlinico Universitario A. Gemelli IRCCS", Rome, Italy
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D'haeseleer E, Huvenne W, Vermeersch H, Meerschman I, Imke K, Servayge L, Versavel O, Van Lierde K. Long-term voice quality outcome after thyroidectomy without laryngeal nerve injury: a prospective 10 year follow up study. JOURNAL OF COMMUNICATION DISORDERS 2021; 91:106109. [PMID: 34034037 DOI: 10.1016/j.jcomdis.2021.106109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/16/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
PURPOSE This study investigates the long-term voice outcome of thyroidectomy up to 10 years after the surgery using a longitudinal prospective study design. METHODS Eighteen participants (6 men and 12 women, mean age: 54 years) who underwent a thyroidectomy between September 2006 and May 2007 were included in this study. A voice assessment protocol consisting of subjective (videolaryngostroboscopic evaluation, auditory- perceptual evaluation, patients' self-report) and objective voice assessments (maximum performance task, acoustic analysis, voice range profile and Dysphonia Severity Index) was used to evaluate the participants' pre- and postoperative voice. Voice measurements were compared before and one week, six weeks, three months and 10 years after the surgery. RESULTS No significant differences over time in auditory-perceptual and objective voice parameters were found, except for shimmer. Only in the first postoperative condition, significantly more patients reported vocal complaints. A progressive amelioration of the vocal folds' movement patterns was observed in the postoperative conditions. CONCLUSION The findings of this small longitudinal prospective study suggest that thyroidectomy without laryngeal nerve injury does not cause a permanent deterioration of the laryngeal aspect or function, vocal fold behavior and the self-perceived, perceptual and objective vocal quality. The increase of the shimmer 10 years post-thyroidectomy may be related to vocal aging.
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Affiliation(s)
- Evelien D'haeseleer
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, Ghent University Hospital, Belgium.
| | - Wouter Huvenne
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Hubert Vermeersch
- Department of Head and Neck Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Iris Meerschman
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Kissel Imke
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Lena Servayge
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Orphee Versavel
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium.
| | - Kristiane Van Lierde
- Center for Speech and Languages Sciences, Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium; Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South-Africa.
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Kim SY, Park JO, Bae JS, Lee SH, Hwang YS, Shim MR, Park YH, Sun DI. How Can We Predict the Recovery from Pitch Lowering After Thyroidectomy? World J Surg 2021; 44:3395-3404. [PMID: 32488661 DOI: 10.1007/s00268-020-05628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Some of patients are suffered from pitch lowering of voice after thyroidectomy. We sought to identify factors predictive of a recovery from lowered pitch voice after thyroid surgery. METHODS We retrospectively reviewed the records of 133 patients who underwent total thyroidectomy to treat papillary carcinoma between January 2012 and February 2013. Of these, we enrolled 78 who exhibited a lower-pitched voice (SFF fall > 12 Hz) at 2 weeks post-operatively than pre-operatively and investigated pitch recovery after 3 months. We subclassified patients into recovery and non-recovery groups and compared videostroboscopic findings, acoustic voice data, and thyroidectomy-related voice questionnaire scores pre-operatively and 2, 8, and 12 weeks post-operatively. RESULTS Vocal cord asymmetry on videostroboscopic examination at 2 weeks post-operatively (odds ratio 19.056, p = 0.001*) was more frequent in the non-recovery group. In acoustic analysis, mean pre-operative SFF was higher in the non-recovery group than the recovery group (190.9 ± 27.5 and 180.9 ± 24.6 Hz, respectively; p = 0.030*). Also, a reduction in the SFF of > 19.6 Hz, at 2 weeks post-operatively versus pre-operatively, predicted non-recovery of pitch-lowering in patients with reduced SFF within post-operative 3 months, with 72.0% sensitivity and 71.2% specificity. After 6 months of follow-up, no patient who exhibited an SFF fall > 19.6 Hz recovered to within 10 Hz of the pre-operative value. CONCLUSION A reduction in the speaking fundamental frequency (SFF) > 19.6 Hz at 2 weeks post-operatively predicted persisting lowering of voice pitch after thyroidectomy among those with lower-pitched voices after surgery. Pre-operative high SFF and post-operative stroboscopic findings including vocal cord asymmetry at 2 weeks post-operatively also predicted persisting lowering of voice pitch for 3 months.
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Affiliation(s)
- Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Inje University of Korea, Busan, Republic of Korea
| | - Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja-Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Shin Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Ran Shim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hak Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Saeedi M, Yadegari M, Aghadoost S, Naderi M. Vocal tract discomfort and voice handicap index in patients undergoing thyroidectomy. LOGOP PHONIATR VOCO 2020; 47:49-55. [PMID: 33371756 DOI: 10.1080/14015439.2020.1864466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE This study aims to investigate the frequency and severity of vocal tract discomfort (VTD) symptoms and to determine the relationship between VTD and type of thyroidectomy, voice problem history, vocal abuse, and misuse behaviors, and the voice handicap index (VHI) in the thyroidectomy patients undergoing thyroidectomy, pre- and post-operatively pre- and post-thyroidectomy. MATERIALS The sample comprised 21 thyroidectomy patients undergoing thyroidectomy, including 10 patients with total thyroidectomy and 11 patients with partial thyroidectomy. The participants underwent videolaryngoscopy examination and completed the voice history questionnaire, the VTD scale, and the VHI, before and after the surgery. RESULTS Dryness was the most frequently occurring symptom, pre- and post-thyroidectomy. Participants with total thyroidectomy reported significantly higher frequency and severity of tickling than those in the preoperative status (p<.05). The frequency and severity of many VTD symptoms in the participants with voice problems and a vocal abuse and misuse history were higher than those without such a history at both assessment times (p<.05). There was significant correlation between the frequency and severity of VTD and VHI scores, pre-thyroidectomy pre-operatively (r = 0.488-0.575, p<.05). CONCLUSIONS An increment in the frequency and severity of tickling was reported by total thyroidectomy patients, post-thyroidectomy post-operatively. The type of thyroidectomy, voice problem history, and vocal abuse and misuse behaviors seem to influence the frequency and severity of VTD. Considering the correlation between VTD and VHI, the VTD scale provides important clinical information and can be used for evaluation and consultation purposes.
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Affiliation(s)
- Masoumeh Saeedi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Meysam Yadegari
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Samira Aghadoost
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Naderi
- New Hearing Technologies Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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13
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Seok J, Ryu YM, Jo SA, Lee CY, Jung YS, Ryu J, Ryu CH. Singing voice range profile: New objective evaluation methods for voice change after thyroidectomy. Clin Otolaryngol 2020; 46:332-339. [PMID: 33236412 DOI: 10.1111/coa.13673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 10/11/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND After surgery in the thyroid region, patients may present with phonation or singing difficulty, even within their vocal range. We designed a novel voice evaluation method that reflects subjective and objective voice complications of the surgery. METHODS This tool recorded patients' voice ranges while singing, which was named the singing voice range profile (singing VRP). Patients were asked to sing "Happy Birthday," which has a one-octave scale, at a comfortable tone and intensity. The singing VRP, standard VRP and voice handicap index-10 (VHI-10) results were recorded before thyroidectomy and 1 and 3 months after thyroidectomy for 128 patients. For subgroup analysis, a group where the maximum F0 of standard VRP in 1 month postoperatively was lower than the highest singing F0 of the preoperative singing VRP was defined as "Collapsed group" and the other group was "Preserved group." RESULTS The changes in the highest, lowest and range of singing fundamental frequency (F0 ) had decreased at 1 month postoperatively. Subsequently, they had improved significantly at 3 months postoperatively but were lower than those preoperatively (all P < .05, except for the change in the lowest singing F0 between 1 and 3 months postoperatively, P = .274). In the subgroup analysis, the singing range of the collapsed group (n = 65) showed significantly lower VHI-10 scores, range of vocal F0 and singing F0 than those of the preserved group (n = 63) at 1 and 3 months postoperatively (all P < .001). At 3 months postoperatively, the singing F0 range in the preserved group had recovered to the range before surgery (13.0 ± 1.3 vs. 13.1 ± 1.4, P = .746 for the preserved group, and 13.0 ± 1.3 vs 11.5 ± 2.4, P < .001 for the collapsed group). CONCLUSIONS Parameters measured by singing VRP showed a trend similar to the change in VHI-10 and the maximum F0 of standard VRP. In addition, singing VRP allowed a qualitative classification of the postoperative voice function when combined with standard VRP. Therefore, it can be used as a supplementary voice evaluation tool to reflect the physiologic and functional aspects of voice.
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Affiliation(s)
- Jungirl Seok
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Youn Mi Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Seong Ae Jo
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Chang Yoon Lee
- Department of Radiology, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Yuh-Seog Jung
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
| | - Chang Hwan Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang-si, Republic of Korea
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Kim SY, Kim GJ, Lee DH, Bae JS, Lee SH, Kim JS, Hwang YS, Shim MR, Park YH, Sun DI. Voice change after thyroidectomy without vocal cord paralysis: Analysis of 2,297 thyroidectomy patients. Surgery 2020; 168:1086-1094. [PMID: 32919781 DOI: 10.1016/j.surg.2020.07.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Some patients experience long-term voice change after thyroidectomy. One of the most common symptoms of voice change is pitch lowering, which is closely related to unfavorable voice quality. Here we observed voice outcomes for 6 months of follow-up after thyroidectomy to identify factors closely related to low-pitched voice. METHODS We retrospectively reviewed the records of 2,297 patients who underwent thyroidectomy between January 2014 and December 2017. All the patients had their vocal status examined using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-Related Voice Questionnaire scores. We stratified patients into 2 groups (low-pitched voice versus favorable voice) according to pitch lowering (reduction in speaking fundamental frequency ≥12 Hz 1 month after thyroidectomy compared to the preoperative value). We compared preoperative data with postoperative data collected 1, 3, and 6 months after thyroidectomy to identify factors contributing to low-pitched voice. RESULTS Univariate logistic regression analyses showed that factors related to low-pitched voice were female sex, older age, low body weight, short stature, and a high positive lymph node ratio. Multivariate analyses showed that female sex and older age were significantly associated with a negative prognosis for low-pitched voice 1 month after thyroidectomy (odds ratios 0.41 and 1.04, respectively; P < .001). Receiver operating characteristic curves for predicting sustained low-pitched voice during 6 months showed that speaking fundamental frequency ≥12.48 Hz 1 month after thyroidectomy was the optimal cutoff value, with 87.9% sensitivity and 95.8% specificity (P < .001). CONCLUSION Female sex and older age are strongly associated with increased risk for low-pitched voice after thyroidectomy. Speaking fundamental frequency ≥12.48 Hz 1 month after thyroidectomy can be used to predict sustained low-pitched voice after thyroidectomy.
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Affiliation(s)
- Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Inje University of Korea, Busan, Republic of Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Hyun Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ja-Seong Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Hee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jeong-Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeon-Shin Hwang
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Ran Shim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young-Hak Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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15
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Can Voice Pitch Be Preserved in Patients after Transoral Endoscopic Thyroidectomy Vestibular Approach? J Clin Med 2020; 9:jcm9092777. [PMID: 32867245 PMCID: PMC7564877 DOI: 10.3390/jcm9092777] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/20/2020] [Accepted: 08/23/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has become increasingly popular. Several reports have emphasized the safety and efficacy of this new approach. However, there is no report on functional voice outcomes, including voice pitch change after TOETVA. Methods: The functional voice outcomes of patients undergoing TOETVA were compared with those of patients undergoing conventional thyroidectomy. A total of 82 consecutive patients were included in the study: 44 underwent thyroid lobectomy via TOETVA (transoral group) and 38 underwent thyroid lobectomy via the classic cervical approach (open group). Thyroidectomy-related voice questionnaire (TVQ), perceptual voice analysis, fiberoptic laryngoscopic and videolaryngostroboscopic examinations, and acoustic analysis were carried out before and one month after surgery. The changes in these values after surgery and the differences between the transoral and open groups were analyzed. Results: We found no significant postoperative change in voice workups in either group. The mean high pitch decreased (from 367.91 ± 120.98 to 325.80 ± 100.86 Hz, p = 0.069) in the transoral group, but statistical significance was not attained. Clinically significant changes in pitch (postoperative change in speaking fundamental frequency, ΔSFF ≥ 12) after surgery were evident in seven (15.91%) patients in the transoral group and eight (21.05%) patients in the open group without significant difference (p = 0.579). Conclusions: This is the first study to assess functional voice outcomes (including pitch) after TOETVA compared with conventional open surgery. TOETVA was associated with good voice outcomes without any significant drop in pitch.
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16
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Han S, Kwon TK, Chai YJ, Park J, Lee DY, Lee KE, Kim HY, Hwang KT, Yi KH. Functional Voice and Swallowing Outcome Analysis After Thyroid Lobectomy: Transoral Endoscopic Vestibular Versus Open Approach. World J Surg 2020; 44:4127-4135. [DOI: 10.1007/s00268-020-05731-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/29/2023]
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17
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Hwang YS, Shim MR, Kim GJ, Lee DH, Nam IC, Park JO, Kim SY, Park YH, Bae JS, Lee SH, Kim JS, Sun DI. Development and Validation of the Thyroidectomy-Related Voice and Symptom Questionnaire (TVSQ). J Voice 2020; 36:145.e15-145.e22. [PMID: 32451255 DOI: 10.1016/j.jvoice.2020.04.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Common symptoms after thyroidectomy include voice change and throat and neck discomfort. But no common questionnaire has been developed. This study was performed to evaluate the reliability and validity of the Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ). METHODS Fourty items of the TVSQ were divided into 20 items related to the "voice change" and "throat and neck discomfort" subcategories, using item generation. Through a reduction process, 20 items were removed and 20 items were used. For the patients after thyroidectomy, we evaluated the reliability and validity of each of the 20 items through item discrimination, test-retest reliability, concurrent validity, and external validity by comparing normal group and laryngeal disease patients. Also, the patients were compared before as well as 2 and 4 weeks after thyroidectomy. RESULTS Item discrimination assessment showed a significant correlation between TVSQ total score and both the TVSQ "voice change" score (r = 0.908**) and TVSQ "throat and neck discomfort" score (r = 0.862**). Test-retest reliability assessment showed a significant correlation between TVSQ total scores at 2 and 4 weeks postoperatively (r = 0.764**). Concurrent validity assessment revealed that the TVSQ showed high correlations with other voice questionnaires (Voice Handicap Index, Reflux Finding Index, and Vocal Track Discomfort Scale; r = 0.538**-0.830**). External validity assessment revealed that the TVSQ was suitable for patients after thyroidectomy (P < 0.000**). CONCLUSIONS Validity and reliability tests revealed that the TVSQ was suitable for assessment of the subjective feelings of patients with voice change and throat and neck discomfort after thyroidectomy.
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Affiliation(s)
- Yeon-Shin Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Mi-Ran Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Geun-Jun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Dong-Hyun Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jun-Ook Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Sang-Yeon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea
| | - Young-Hak Park
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Ja-Sung Bae
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - So-Hee Lee
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Jeong-Soo Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Republic of Korea.
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18
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Kwon HK, Cheon YI, Shin SC, Kim GH, Lee YW, Sung ES, Lee JC, Lee BJ. Clinical Significance of the Preoperative Thyroidectomy-Related Voice Questionnaire Score in Thyroid Surgery. J Voice 2020; 36:145.e7-145.e13. [PMID: 32389503 DOI: 10.1016/j.jvoice.2020.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 03/26/2020] [Accepted: 04/01/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The thyroidectomy-related voice questionnaire (TVQ) is an efficient screening tool for detecting postoperative vocal dysfunction. The aim of this study was to confirm the significance of the preoperative TVQ score in thyroid surgery. METHODS We examined 180 women who underwent total thyroidectomy with central lymph node dissection from March 2014 to May 2016. Based on the preoperative TVQ score, participants were categorized under "normal" (TVQ score <5) and "abnormal" (TVQ score ≥5) groups. The laryngoscopic examination and acoustic analysis were performed and the TVQ score assessed before and after surgery (2 weeks, 2 months, and 8 months). RESULTS In the normal group, the TVQ score increased up to 2 months postoperatively and had decreased at 8 months postoperatively but was significantly higher than the preoperative TVQ score. In the abnormal group, the TVQ score increased up to 2 months postoperatively but had recovered similar to the preoperative TVQ score 8 months postoperatively. The preoperative TVQ score in the abnormal group moderately correlated with the final TVQ score; however, the preoperative TVQ score in the normal group did not correlate with the TVQ score 8 months postoperatively. CONCLUSION During preoperative patient counseling, it is important to explain that voice changes without vocal cord palsy may occur postoperatively and that it may take a long time to resolve, particularly in patients with a normal preoperative TVQ score.
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Affiliation(s)
- Hyun-Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yong-Il Cheon
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Geun-Hyo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yeon-Woo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eui-Suk Sung
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jin-Choon Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
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Kletzien H, Macdonald CL, Orne J, Francis DO, Leverson G, Wendt E, Sippel RS, Connor NP. Comparison Between Patient-Perceived Voice Changes and Quantitative Voice Measures in the First Postoperative Year After Thyroidectomy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2019; 144:995-1003. [PMID: 29710208 DOI: 10.1001/jamaoto.2018.0309] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Voice changes after thyroidectomy are typically attributed to recurrent laryngeal nerve injury. However, most postoperative voice changes occur in the absence of clinically evident vocal fold paralysis. To date, no study has compared the prevalence, duration, and consequences of voice-related disability from the patient perspective with use of quantitative vocal measures. Objectives To assess the quality-of-life consequences of postthyroidectomy voice change from the perspective of patients with thyroid cancer and to compare patient-perceived voice changes with changes in quantitative vocal variables at 5 time points in the first postoperative year. Design, Setting, and Participants This prospective mixed methods observational study within a randomized clinical trial occurred at the University of Wisconsin Hospital and Clinics. Participants were 42 patients with clinically node-negative papillary thyroid cancer without a preexisting vocal cord paralysis who were recruited and enrolled from outpatient clinics between June 6, 2014, and March 6, 2017, as part of the ongoing randomized clinical trial. Intervention Total thyroidectomy. Main Outcomes and Measures Semistructured interviews, symptom prevalence, and instrumental voice evaluations (laryngoscopy, phonation threshold pressure, Dysphonia Severity Index, and Voice Handicap Index) occurred at baseline (n = 42) and 2-week (n = 42), 6-week (n = 39), 6-month (n = 35), and 1-year (n = 30) postoperative time points. Results Participants had a mean age of 48 years (interquartile range, 38-58 years; age range, 22-70 years) and were mostly female (74% [31 of 42]) and of white race/ethnicity (98% [41 of 42]). Impaired communication was the primary theme derived from patient interviews from before thyroidectomy to after thyroidectomy. Voice changes were perceived by 24 participants at 2 weeks after thyroidectomy. After surgery, voice symptoms were prevalent and persisted for 50% (21 of 42) of participants out to at least 1 year of follow-up. Quantitative vocal perturbations were detected in the Dysphonia Severity Index and Voice Handicap Index at the 2-week follow-up but returned to baseline levels by the 6-week follow-up visit. Conclusions and Relevance Voice changes are common after surgery for papillary thyroid cancer and affect quality of life for many patients out to 1 year of follow-up. Directly querying patients about postoperative voice changes and questioning whether commonly used aerodynamic and acoustic variables detect meaningful voice changes are important in identifying patients whose quality of life has been affected by postthyroidectomy dysphonia. Trial Registration ClinicalTrials.gov Identifier: NCT02138214.
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Affiliation(s)
- Heidi Kletzien
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison
| | | | - Jason Orne
- Qualitative Health Research Consultants, Madison, Wisconsin.,Department of Sociology, Drexel University, Philadelphia, Pennsylvania
| | - David O Francis
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison.,Wisconsin Surgical Outcomes Research Program, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison.,Division of Endocrine Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison
| | - Glen Leverson
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison
| | - Elizabeth Wendt
- Division of Endocrine Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison
| | - Rebecca S Sippel
- Division of Endocrine Surgery, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison
| | - Nadine P Connor
- Division of Otolaryngology-Head and Neck Cancer, Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, Madison.,Department of Biomedical Engineering, University of Wisconsin-Madison, Madison.,Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison
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20
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Meerschman I, Claeys S, Bettens K, Bruneel L, D'haeseleer E, Van Lierde K. Massed Versus Spaced Practice in Vocology: Effect of a Short-Term Intensive Voice Therapy Versus a Long-Term Traditional Voice Therapy. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:611-630. [PMID: 30950739 DOI: 10.1044/2018_jslhr-s-18-0013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Purpose The aim of this study was to compare the effect of a short-term intensive voice therapy (IVT) with a long-term traditional voice therapy (TVT) on the vocal quality, vocal capacities, psychosocial impact, vocal tract discomfort, laryngological anatomy/physiology, and session attendance of patients with dysphonia. An additional comparison was made between an individual IVT (IVT-I) and a group IVT (IVT-G). Method A longitudinal, prospective controlled trial was used. Forty-six adults diagnosed with dysphonia were assigned to 1 of the 3 treatment groups. The IVT groups practiced with a frequency of 1 hr 20 min a day and a duration of 2 weeks. The TVT group practiced with a frequency of two 30-min sessions a week and a duration of 6 months. Both therapy programs were content-identical and guided by the same voice therapist. A multidimensional voice assessment consisting of both objective (maximum performance task, aerodynamic measurements, voice range profile, acoustic analysis, multiparametric voice quality indices) and subjective (subject's self-report, auditory-perceptual evaluation, flexible videolaryngostroboscopy) outcomes was used to evaluate the participants' voice. Results IVT made an equal progress in only 2 weeks and 12 hr of therapy compared with TVT that needed 6 months and 24 hr of therapy. IVT-I and IVT-G showed comparable results. Session attendance was clearly higher in IVT compared with TVT. Long-term follow-up results (1 year) were positive for the 3 groups, except for the self-reported psychosocial impact that increased in the IVT-I group. Conclusions Short-term IVT is at least equally effective in treating patients with dysphonia as long-term TVT. Group treatment seemed as effective as individual treatment. Attendance and cost-effectiveness are important advantages of IVT. A potential drawback might be an insufficient psychosocial progress. The golden mean between intensive and traditional treatment might therefore be an achievable, effective, and efficient solution for everyday clinical practice. Supplemental Material https://doi.org/10.23641/asha.7761872.
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Affiliation(s)
- Iris Meerschman
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Sofie Claeys
- Department of Otorhinolaryngology, Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Research group: Speech, Language and Hearing Sciences, Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Delgado-Vargas B, Lloris Romero-Salazar A, Cobeta I. Vocal Changes Following Thyroid Surgery: Prospective Study of Objective and Subjective Parameters. J Voice 2019; 33:27-32. [DOI: 10.1016/j.jvoice.2017.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 11/25/2022]
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Long-term functional voice outcomes after thyroidectomy, and effect of endotracheal intubation on voice. Eur Arch Otorhinolaryngol 2018; 275:3049-3058. [DOI: 10.1007/s00405-018-5145-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 09/20/2018] [Indexed: 11/28/2022]
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Park MW, Baek SK, Park EH, Jung KY. Long-term voice outcome after thyroidectomy using energy based devices. Auris Nasus Larynx 2018; 45:527-532. [DOI: 10.1016/j.anl.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
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Lateral neck dissection affects the voice in thyroid cancer patients. The Journal of Laryngology & Otology 2017; 131:853-859. [DOI: 10.1017/s0022215117001542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:This study aimed to identify the effect of lateral neck dissection on voice change in thyroidectomised patients.Methods:Medical records from 264 patients who underwent thyroidectomy with (n= 65) or without (n= 199) lateral neck dissection were reviewed. Clinical and voice evaluation data were compared between the two groups.Results:Patients who underwent surgery that included lateral neck dissection had lower fundamental frequencies and speaking fundamental frequencies. They also had a higher incidence of asymmetric mucosal wave and vocal fold oedema on videostroboscopy during the first month after surgery, with the incidence of vocal fold oedema remaining significantly higher at three months. Self-assessed voice quality scores were significantly higher in lateral neck dissection patients at both one and three months after surgery.Conclusion:In thyroidectomised patients, lateral neck dissection lowers the vocal pitch in the initial period after surgery and induces vocal fold oedema that persists for several months. Although most objective parameters improved within a month, subjective symptoms lasted for longer.
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Papadakis CE, Asimakopoulou P, Proimos E, Perogamvrakis G, Papoutsaki E, Chimona T. Subjective and Objective Voice Assessments After Recurrent Laryngeal Nerve-Preserved Total Thyroidectomy. J Voice 2017; 31:515.e15-515.e21. [DOI: 10.1016/j.jvoice.2016.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 12/10/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
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Lang BHH, Wong CKH, Ma EPM. Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia 2017; 33:868-874. [PMID: 28540785 DOI: 10.1080/02656736.2017.1305127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND High intensity focussed ultrasound (HIFU) is a promising non-surgical treatment for symptomatic benign thyroid nodule. We aimed to compare early efficacy, safety and voice quality between HIFU ablation and open thyroidectomy. METHODS Consecutive patients who underwent single-session HIFU ablation or a hemithyroidectomy for symptomatic benign thyroid nodule were included. The 6-month extent of nodule shrinkage, symptom improvement score, thyroid function, hospital stay and cost were compared between the two procedures. Safety was defined by absence of major complications like recurrent laryngeal nerve injury and skin burn. Voice quality was assessed by a computerised multi-dimensional voice programme and a Voice Handicap Index (VHI) questionnaire 1-month after treatment. RESULTS Altogether, 43 patients had HIFU and 103 patients had a hemithyroidectomy. In the HIFU group, the extent of nodule shrinkage at 6-month was 51.71 ± 16.04%. No patients in the HIFU group suffered skin burn or hypothyroidism. The HIFU group had a significantly shorter length of hospital stay (0.3 vs. 1.0 day, p < 0.001), lower incidence of subclinical hypothyroidism (1/43 vs. 21/103, p = 0.008), higher symptom improvement score (p = 0.009) and was less costly (USD 1923.1 vs. USD 5384.6). Relative to HIFU, pitch quality also worsen after surgery (p < 0.05). CONCLUSIONS Relative to surgery, single HIFU ablation appeared efficacious and safe. Apart from shorter hospital stay, less subclinical hypothyroidism, being scar-less, lower cost and more symptom improvement, HIFU patients were less affected by a pitch problem in the first month. This study provides a strong argument for HIFU ablation as a treatment for symptomatic benign thyroid nodule.
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Affiliation(s)
- Brian H H Lang
- a Department of Surgery , The University of Hong Kong , Hong Kong , Hong Kong, China
| | - Carlos K H Wong
- b Department of Family Medicine and Primary Care , The University of Hong Kong , Ap Lei Chau , Hong Kong, China
| | - Estella P M Ma
- c Division of Speech and Hearing Sciences , The University of Hong Kong , Hong Kong , Hong Kong, China
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Lee DY, Lee KJ, Hwang SM, Oh KH, Cho JG, Baek SK, Kwon SY, Woo JS, Jung KY. Analysis of Temporal Change in Voice Quality After Thyroidectomy: Single-institution Prospective Study. J Voice 2017; 31:195-201. [DOI: 10.1016/j.jvoice.2016.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 04/28/2016] [Indexed: 10/21/2022]
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Keseroglu K, Bayir O, Umay EK, Saylam G, Tatar EC, Ozdek A, Korkmaz MH. Laryngeal electromyographic changes in postthyroidectomy patients with normal vocal cord mobility. Eur Arch Otorhinolaryngol 2017; 274:1925-1931. [PMID: 28132134 DOI: 10.1007/s00405-016-4442-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 12/22/2016] [Indexed: 11/27/2022]
Abstract
Thyroidectomy has been used for the treatment of thyroid disease for more than 100 years. In spite of the advancement of surgical techniques, there is still a risk of laryngeal nerve injury. The risk of partial or complete injury still depends on some surgical and disease-related factors. The aim of this study is to show the partial injury and to establish these risk factors via laryngeal electromyographic analysis (LEMG) in postthyroidectomy patients with normal vocal cord motion and mucosal anatomy. Patients who had undergone thyroid surgery were enrolled in this prospective study. LEMG analysis was performed to all patients with normal vocal cord mobility preoperatively and was repeated after the first and the third months of surgery. Thyroarytenoid (TA) and cricothyroid (CT) muscles were used to evaluate recurrent and external branch of superior laryngeal nerves, respectively. Four of the 32 patients had mild-to-moderate degrees of partial LEMG changes during preoperative LEMG analysis of TA and CT muscles on each side. After 3 months of surgery, there was a statistically significant worsening of LEMG findings in the right and left external branches of superior and left recurrent laryngeal nerves. Disease and surgery-related risk factors were analyzed. However, there was no significant relationship on the progression of LEMG findings according to these parameters. This is the first prospective study which supports the risk of progression of LEMG changes in patients with normal laryngoscopic examination after thyroid surgery. No reliable significant risk factor was found influencing the LEMG progression.
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Affiliation(s)
- Kemal Keseroglu
- Otolaryngology Department, Diskapi Yildirim Beyazit Training and Research Hospital, 1426 Street No: 28/11 Cukurambar, 06510, Ankara, Turkey.
| | - Omer Bayir
- Otolaryngology Department, Diskapi Yildirim Beyazit Training and Research Hospital, 1426 Street No: 28/11 Cukurambar, 06510, Ankara, Turkey
| | - Ebru Karaca Umay
- Physical Medicine and Rehabilitation Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Guleser Saylam
- Otolaryngology Department, Diskapi Yildirim Beyazit Training and Research Hospital, 1426 Street No: 28/11 Cukurambar, 06510, Ankara, Turkey
| | - Emel Cadalli Tatar
- Otolaryngology Department, Diskapi Yildirim Beyazit Training and Research Hospital, 1426 Street No: 28/11 Cukurambar, 06510, Ankara, Turkey
| | | | - Mehmet Hakan Korkmaz
- Faculty of Medicine Otolaryngology Department, Yildirim Beyazit University, Ankara, Turkey
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Uludag M, Aygun N, Kartal K, Citgez B, Besler E, Yetkin G, Kaya C, Ozsahin H, Mihmanli M, Isgor A. Contribution of intraoperative neural monitoring to preservation of the external branch of the superior laryngeal nerve: a randomized prospective clinical trial. Langenbecks Arch Surg 2016; 402:965-976. [PMID: 28035477 DOI: 10.1007/s00423-016-1544-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of intraoperative neuromonitoring (IONM) on the injury rate of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. METHODS A total of 133 consenting patients (98 female, 35 male; mean age, 45.6 ± 11.7 years) undergoing thyroidectomy were randomly assigned to 2 groups. In group 1 (n = 65 patients, 105 nerves), superior thyroid pole dissection was performed with no attempt to identify the EBSLN; in group 2 (n = 68 patients, 106 nerves), IONM was used to identify the EBSLN during surgery. EBSLN function was evaluated by intraoperative electromyography of the cricothyroid muscle. The EBSLN Voice Impairment Index-5 (VII-5) was conducted preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was the prevalence of EBSLN injury. The secondary outcomes were the identification rate of the EBSLN using IONM and changes in postoperative voice performance. RESULTS EBSLN injury was detected in eight (12.3%) patients and nine (8.6%) nerves in group 1 and in one (1.5%) patient and one (0.9%) nerve in group 2 (patients, p = 0.015; nerves, p = 0.010). IONM contributed significantly to visual (p < 0.001) and functional (p < 0.001) nerve identification in group 2. The VII-5 indicated more voice changes in group 1 than 2 at 1, 3, and 6 months postoperatively (p = 0.012, p = 0.015, and p = 0.02, respectively). CONCLUSION IONM contributes to visual and functional identification of the EBSLN and decreases the rate of EBSLN injury during superior pole dissection. Routine use of IONM to identify the EBSLN will minimize the risk of injury during thyroidectomy.
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Affiliation(s)
- Mehmet Uludag
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Nurcihan Aygun
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kinyas Kartal
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Bulent Citgez
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Evren Besler
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Yetkin
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cemal Kaya
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Ozsahin
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mihmanli
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Adnan Isgor
- General Surgery, Bahcesehir University Medical Faculty, Istanbul, Turkey
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Quantitative study of voice dysfunction after thyroidectomy. Surgery 2016; 160:1576-1581. [DOI: 10.1016/j.surg.2016.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 04/25/2016] [Accepted: 07/14/2016] [Indexed: 11/22/2022]
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Park JO, Bae JS, Lee SH, Shim MR, Hwang YS, Joo YH, Park YH, Sun DI. Multivariate Analysis of Risk Factors in the Development of a Lower-Pitched Voice After Thyroidectomy. Ann Otol Rhinol Laryngol 2016; 126:117-123. [DOI: 10.1177/0003489416675875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Thyroid surgeons frequently encounter outpatients with mobile vocal cords complaining of lower-pitched voices following thyroidectomy. This study investigated the clinical and pathological parameters affecting voice pitch following thyroid surgery. Methods: We analyzed the data of 393 patients with mobile vocal cords and who also underwent thyroid surgery. Speaking fundamental frequency (SFF) and fundamental frequency (F0) were compared before and after surgery. Results: Approximately 26.7% of patients had significantly lowered SFFs (ΔSFF ≥ 12 Hz), and 30.2% exhibited significantly lower sustained vowel F0s (ΔF0 ≥ 12 Hz) following thyroid surgery. On multivariate analysis, only gender: female remained a significant predictor of a clinically significant change in SFF following thyroid surgery ( P < .001). Gender: female and extent of surgery: total remained significant predictors of a clinically significant change in F0 after surgery ( P = .006 and P = .007, respectively). Conclusions: Appreciable proportions of patients experience lower-pitched voice and related vocal symptoms early after thyroid surgery. Such problems develop more frequently in females who underwent total thyroidectomy.
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Affiliation(s)
- Jun-Ook Park
- Department of Otolaryngology Head and Neck Surgery, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea
| | - Ja-Sung Bae
- Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, South Korea
| | - So-Hee Lee
- Department of Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, South Korea
| | - Mi-Ran Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Yeon-Shin Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Young-Hoon Joo
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Young Hak Park
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, Republic of Korea
| | - Dong-Il Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul St Mary’s Hospital, Seoul, Republic of Korea
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Hammer GP, Tomazic PV, Vasicek S, Graupp M, Gugatschka M, Baumann A, Konstantiniuk P, Koter SH. Carotid endarterectomy significantly improves postoperative laryngeal sensitivity. J Vasc Surg 2016; 64:1303-1310. [DOI: 10.1016/j.jvs.2016.04.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/07/2016] [Indexed: 11/25/2022]
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Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment. Eur Arch Otorhinolaryngol 2016; 273:4543-4547. [PMID: 27338720 DOI: 10.1007/s00405-016-4163-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/15/2016] [Indexed: 01/09/2023]
Abstract
Voice symptoms are frequently reported early after thyroidectomy, even in the absence of laryngeal nerves injury. We evaluated the short-term outcomes of these functional alterations. Thirty-nine patients were enrolled in a prospective observational trial, evaluating voice function before and 3 months after uncomplicated thyroidectomy, using VoiSS as assessed using a validated patient rated questionnaire; and perceptual voice analysis using GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain). Impact of dysphonia on patient's life using VoiSS questionnaire revealed differences between pre- and postoperative assessment. There was statistically significant worsening in the impairment subgroup of VoiSS (p = 0.027). GRBAS evaluation was consistent between the three independent raters but showed differences between pre- and postoperative voice assessment. Age, TSH and a preoperative finding of laryngopharyngeal reflux significantly predicted quality of voice after thyroid surgery (all p < 0.004), as identified by the GRBAS assessment tool, but not type of surgery, gender or smoking status; although prediction of total variance in changes of voice was modest (r 2 = 0.07). Voice changes may occur after thyroidectomy without evident laryngeal nerve injury. Patients should be made aware of possible mild changes in voice even after uncomplicated thyroid surgery and this might be considered to be part of the informed consent.
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Park JO, Bae JS, Lee SH, Shim MR, Hwang YS, Joo YH, Park YH, Sun DI. The Long-Term Prognosis of Voice Pitch Change in Female Patients After Thyroid Surgery. World J Surg 2016; 40:2382-90. [DOI: 10.1007/s00268-016-3511-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shin YJ, Hong KH. Cepstral Analysis of Voice in Patients With Thyroidectomy. Clin Exp Otorhinolaryngol 2016; 9:157-62. [PMID: 27090273 PMCID: PMC4881323 DOI: 10.21053/ceo.2015.00199] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 03/04/2015] [Accepted: 03/18/2015] [Indexed: 11/25/2022] Open
Abstract
Objectives The vocal changes after a thyroidectomy are temporary and nonsevere, therefore, obtaining accurate analytical results on the pathological vocal characteristics following such a procedure is difficult. For a more objective acoustic analysis, this study used the cepstral analysis method to examine changes in the patients’ voices during the perioperative period regarding sustained vowel phonation. Methods The sustained phonation of the five vowels (i.e., /a/, /e/, /i/, /o/, and /u/) by 35 patients with thyroidectomy were recorded by using a Multi-Speech program. Of the 35 patients, 10 were men and 25 were women, with an average age of 51.5 years. Voice data were collected a total of 3 times (preoperatively, 5–7 days after the operation, and 6 weeks after the operation) and were edited according to each fragment (on-set, mid, and off-set) for cepstral analysis. Results The cepstral analysis on the patients’ voices revealed no significant differences between the examination periods of all vowel phonations. However, analysis of the on-set fragment of the vowel /i/ revealed pathological characteristics in which the cepstral measurements of the voice were significantly lower after the operation than before the operation, with the cepstral measurements of the voice increasing further 6 weeks following surgery. Conclusion The results of the acoustic analysis on the on-set fragment of the vowel /i/ will be important data for characterizing the vocal changes during the perioperative period. This study contributes to future research on the mechanisms underlying changes in the voice of patients with a history of thyroid or neck surgery.
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Affiliation(s)
- Yu Jeong Shin
- Department of Speech-Language Therapy, Howon University, Gunsan, Korea
| | - Ki Hwan Hong
- Department of Otolaryngology-Head and Neck Surgery, Research Institute of Clinical Medicine-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Lang BHH, Wong CKH, Ma EPM. A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy. Laryngoscope 2015; 126:528-37. [DOI: 10.1002/lary.25452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/17/2015] [Accepted: 05/19/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Carlos K. H. Wong
- Department of Family Medicine and Primary Care; 3/F Ap Lei Chau Clinic
| | - Estella P. M. Ma
- Division of Speech and Hearing Sciences; the University of Hong Kong; Hong Kong SAR the People's Republic of China
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Holler T, Anderson J. Prevalence of voice & swallowing complaints in Pre-operative thyroidectomy patients: a prospective cohort study. J Otolaryngol Head Neck Surg 2014; 43:28. [PMID: 25017899 PMCID: PMC5011810 DOI: 10.1186/s40463-014-0028-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 07/05/2014] [Indexed: 12/17/2022] Open
Abstract
Background Compressive symptoms are common in patients with thyroid disease and are an accepted indication for thyroidectomy. The objective of this study was to evaluate the prevalence and severity of voice and swallowing complaints in pre-operative thyroidectomy patients and to compare these with thyroid volume, thyroid pathology and laryngopharyngeal reflux. Methods A consecutive case series design was performed. All patients undergoing a thyroidectomy (partial or total) at a tertiary care centre during a 2 year period were invited to participate. Fifty nine (10 male, 49 female) aged 19–73 were enrolled (59.3% total thyroidectomy, 40.7% partial thyroidectomy). Voice and swallowing complaints were subjectively evaluated using the Voice Handicap Index (VHI) and the Modified Swallowing Impairment Score (MSIS), respectively. All patients completed the Reflux Symptom Index (RSI) and underwent videostroboscopy. Vocal function was objectively evaluated using perceptual ratings (GRBAS) and acoustic voice analysis (jitter, shimmer, maximum phonation time, maximum fundamental frequency range). The relationship between voice and swallowing symptoms was compared with thyroid volume and surgical pathology. Results and discussion The average VHI score was 8.39, representing normal voice scores. Of the objective voice measures, only jitter and a subset of GRBAS measures were slightly elevated. Swallowing complaints were reported at least “some of the time” by 25 patients (41.7%), and “often or always” by 16 patients (26.7%). Of the patients with voice and swallowing complaints, 68.4% and 56%, respectively, had elevated RSI scores consistent with laryngopharyngeal reflux. No correlation was found with thyroid volume or thyroid pathology. Conclusions Swallowing complaints appear to be common in pre-operative thyroidectomy patients. A large percentage, however, have associated laryngopharyngeal reflux which may in part account for these symptoms. Patients presenting with compressive thyroid symptoms should be evaluated for laryngopharyngeal reflux, and treated where appropriate.
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Affiliation(s)
- Theresa Holler
- Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8C-129, Toronto, M5B 1 W8, ON, Canada.
| | - Jennifer Anderson
- Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8C-129, Toronto, M5B 1 W8, ON, Canada. .,Voice Disorders Clinic, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8 Cardinal Carter North, Toronto, M5B 1 W8, ON, Canada.
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Varaldo E, Ansaldo GL, Mascherini M, Cafiero F, Minuto MN. Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves. Front Endocrinol (Lausanne) 2014; 5:108. [PMID: 25076936 PMCID: PMC4097206 DOI: 10.3389/fendo.2014.00108] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 06/23/2014] [Indexed: 11/25/2022] Open
Abstract
THE CERVICAL BRANCHES OF THE VAGUS NERVE THAT ARE PERTINENT TO ENDOCRINE SURGERY ARE THE SUPERIOR AND THE INFERIOR LARYNGEAL NERVES: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB) is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle) varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified, the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN) runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction, and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve, which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a low range.
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Affiliation(s)
- Emanuela Varaldo
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
- *Correspondence: Emanuela Varaldo, Oncologia Chirurgica, IRCCS AOU San Martino – IST, L.go Rosanna Benzi 10, Genoa 16132, Italy e-mail:
| | - Gian Luca Ansaldo
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino – IST, Genoa, Italy
| | - Matteo Mascherini
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino – IST, Genoa, Italy
| | - Ferdinando Cafiero
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Michele N. Minuto
- U.O. Chirurgia 1, Department of Surgery, IRCCS AOU San Martino – IST, Genoa, Italy
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
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Park JO, Bae JS, Chae BJ, Kim CS, Nam IC, Chun BJ, Shim MR, Hwang YS, Kim MS, Sun DI. How can we screen voice problems effectively in patients undergoing thyroid surgery? Thyroid 2013; 23:1437-44. [PMID: 23829579 DOI: 10.1089/thy.2013.0262] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Voice problems following thyroid surgery are well known, and perioperative voice analysis in patients undergoing thyroidectomy no longer seems optional. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Therefore, we designed this study to develop an efficient and cost-effective screening tool for detecting voice disorders following thyroidectomy. METHODS We developed the Perioperative Voice-Screening Protocol for Thyroid Surgery (PVST) using the Thyroidectomy-Related Voice Questionnaire (TVQ) to provide a cost-effective diagnostic flow chart for patients following thyroidectomy. The TVQ is a simple questionnaire that was developed at our institution and has already demonstrated its effectiveness in detecting pre- and postthyroidectomy voice-related disorders in our previous studies. To investigate the PVST, we enrolled 242 subjects who underwent thyroidectomy and let them follow the PVST. All subjects underwent a voice work-up by a voice specialist to verify the predictive value of the protocol. RESULTS Using PVST, we could effectively screen for abnormal preoperative laryngeal findings with sensitivity and specificity of 82.1% and 50.5%, respectively, especially laryngeal benign mucosal disease with sensitivity and specificity of 100% and 45.6%, respectively. We could also screen for postoperative voice-related problems with sensitivity and specificity of 100% and 50.4% for detecting vocal-cord palsy, and 66.7% and 51.2% for detecting a low-pitched voice, respectively. If all 242 patients followed the protocol, US $42,768 would be saved, and the PVST was estimated to decrease costs by 43.5%. CONCLUSIONS The PVST is a reliable and cost-effective perioperative screening tool that enables thyroid surgeons to detect patients with voice problems in their routine outpatient clinic for early and appropriate referral to voice specialists.
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Affiliation(s)
- Jun-Ook Park
- 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea , Seoul, Korea
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Maeda T, Saito M, Otsuki N, Morimoto K, Takahashi M, Iwaki S, Inoue H, Tomoda C, Miyauchi A, Nibu KI. Voice quality after surgical treatment for thyroid cancer. Thyroid 2013; 23:847-53. [PMID: 23234370 DOI: 10.1089/thy.2012.0060] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Thyroidectomy is a standard treatment for thyroid cancers. Hoarseness due to the paralysis of the recurrent laryngeal nerve is one of the most common postoperative complications, and has been studied by many investigators. However, voice quality after thyroidectomy in patients in whom recurrent laryngeal nerves were preserved and vocal cord morbidity was endoscopically normal has not been well studied. To understand voice quality after thyroidectomy further, we conducted a time-course analysis of voice quality in patients who had thyroidectomy with normal cord morbidity by various measures. METHODS We evaluated voice parameters including the Voice Handicap Index-10 (VHI-10), the vocal efficacy index, the fundamental frequency (F0), the maximum phonation time (MPT), the mean air flow rate (MFR), jitter, shimmer, and the noise-to-harmonics ratio (NHR) before and after total thyroidectomy (TT) or lobectomy (LO) for thyroid cancers in 110 patients in whom the recurrent laryngeal nerves were preserved without apparent injury and normal vocal cord mobility was confirmed by endoscopic examination. Thirteen patients who underwent parotidectomy were enrolled as controls. RESULTS Immediately after surgery, significant decreases in MPT (p=0.003) and significant increases in jitters, shimmers, and NHR (p=0.0002, 0.02, and 0.03, respectively) were observed in the patients who underwent TT. In comparison with the controls, jitters and NHR were significantly higher in the patients who had a TT (p=0.03, 0.04). MFR was significantly higher in the patients who had an LO than in the controls (p=0.02). As compared with the patients who had an LO, MPT was significantly shorter (p=0.0004) and MFR and NHR were significantly higher (p=0.004, 0.03) in the patients with a TT. In the patients who had a TT, the MPT immediately after the surgery was significantly longer in the patients who had simultaneously neck dissection (ND) in comparison with the patients who did not have ND. However, all these differences gradually decreased and were not significant at one month after surgery. CONCLUSIONS Our results suggest that TT and ND have a distinct impact on voice quality after surgical treatment for thyroid cancer, probably due to slight and transient nerve conduction disorders induced by the manipulation around recurrent laryngeal nerves and/or laryngeal edema induced by the disturbance of venous and lymphatic drainages. However, these changes appear to be temporary, lasting only a few weeks.
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Affiliation(s)
- Tatsuyoshi Maeda
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kobe University, Chuo-ku, Kobe, Japan
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Nam IC, Bae JS, Chae BJ, Shim MR, Hwang YS, Sun DI. Therapeutic Approach to Patients With a Lower-Pitched Voice After Thyroidectomy. World J Surg 2013; 37:1940-50. [DOI: 10.1007/s00268-013-2062-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The Impact of a Voice Counseling Procedure to Select Students With Normal Vocal Characteristics for Starting a Master Program in Speech Language Pathology: A Pilot Study. J Voice 2012; 26:623-8. [DOI: 10.1016/j.jvoice.2011.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 11/04/2011] [Indexed: 11/17/2022]
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Kuhn MA, Bloom G, Myssiorek D. Patient perspectives on dysphonia after thyroidectomy for thyroid cancer. J Voice 2012; 27:111-4. [PMID: 22925427 DOI: 10.1016/j.jvoice.2012.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2012] [Accepted: 07/18/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine the frequency and consequences of patient-reported post-thyroidectomy voice disorder (PTVD) after surgery for thyroid cancer. STUDY DESIGN Retrospective review of data gathered from a survey. PARTICIPANTS Members of the Thyroid Cancer Survivors' Association (ThyCa). METHODS ThyCa members were asked about their thyroid disease and surgery, voice disturbance, impact on quality of life, treatment, and non-identifying demographics in a 36-item electronic questionnaire. Patients with preoperative voice disturbance or vocal fold immobility and those reporting postoperative vocal fold paralysis were excluded. RESULTS A total of 4426 members responded (37% response rate), and PTVD was reported by 51.1% of responders. Most were temporary (85.9%), with a minority reporting permanent hoarseness. Rates of postoperative dysphonia were similar between the extent of surgery and histology. Patients with PTVD predominantly characterized their impairment as loss of loudness and an inability to shout or sing. Nearly a quarter of patients reporting PTVD identified detrimental impact to their professional or personal lives. Only 57 patients (3.4%) were offered voice therapy; however, more than two-thirds of them (73.7%) experienced at least partial improvement. CONCLUSIONS We report the results of a large-scale patient survey to underscore the commonness of postoperative hoarseness and its impact on patients. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Maggie A Kuhn
- Department of Otolaryngology, New York University Langone Medical Center, New York, New York 10016, USA
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Lee J, Na KY, Kim RM, Oh Y, Lee JH, Lee J, Lee JS, Kim CH, Soh EY, Chung WY. Postoperative functional voice changes after conventional open or robotic thyroidectomy: a prospective trial. Ann Surg Oncol 2012; 19:2963-70. [PMID: 22535259 DOI: 10.1245/s10434-012-2253-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2011] [Indexed: 01/01/2023]
Abstract
PURPOSE To use objective and subjective voice function analysis to compare outcomes in patients who had undergone conventional open thyroidectomy or robotic thyroidectomy. METHODS The study involved 88 consecutive patients who underwent thyroid surgery between May 2009 and December 2009; 46 patients underwent a conventional open thyroidectomy, and 42 underwent a robotic thyroidectomy. Auditory perceptual evaluation was used to make subjective assessments of voice function, and videolaryngostroboscopy, acoustic voice analysis with aerodynamic study, electroglottography, and voice range profile were used to make objective assessments. Each assessment was made before surgery, and at 1 week and 3 months after surgery. RESULTS The conventional open and robotic thyroidectomy groups were similar in terms of age, gender ratio, and disease profile. We found that 18 (20.5%) of the 88 patients showed some level of voice dysfunction at 1 week after surgery; that the dysfunction resolved by 3 months after surgery in all cases; and that it was not permanent according to postoperative videolaryngostroboscopy. The conventional open and robotic thyroidectomy groups were found to have similar levels of dysfunction at 1 week after surgery, except for jitter, which was greater in the robotic group. For both groups, any such dysfunction spontaneously resolved by 3 months after surgery, and there were no significant differences between the groups in terms of any voice function parameter. CONCLUSIONS Voice dysfunction was present after both open and robotic thyroidectomy (without any evident laryngeal nerve injury). However, function subsequently normalized to preoperative levels at 3 months after surgery in both groups. Voice function outcomes after robotic thyroidectomy are similar to those after conventional open thyroidectomy.
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Affiliation(s)
- Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Lombardi CP, D’Alatri L, Marchese MR, Maccora D, Monaco ML, De Crea C, Raffaelli M. Prospective Electromyographic Evaluation of Functional Postthyroidectomy Voice and Swallowing Symptoms. World J Surg 2012; 36:1354-60. [DOI: 10.1007/s00268-012-1481-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 2011; 26:1871-7. [PMID: 22205465 DOI: 10.1007/s00464-011-2116-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 12/04/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Voice and swallowing alterations are common complaints after thyroidectomy, even in the absence of laryngeal nerve impairment. However, voice and swallowing functions after robotic thyroidectomy have not been thoroughly investigated. This study compared the functional outcomes for voice and swallowing after robotic thyroidectomy and conventional open thyroidectomy. METHODS The study prospectively analyzed the voice and swallowing functions of patients with thyroid nodules who underwent robotic thyroidectomy by a gasless unilateral axillo-breast (GUAB) approach (50 cases) or by conventional open thyroidectomy (61 cases) from September 2009 to October 2010. Videolaryngostroboscopy or flexible laryngoscopy was performed pre- and postoperatively. Subjective voice and swallowing alterations were assessed by questionnaire preoperatively and then 1 day, 1 week, 1 month, 3 months, and 6 months postoperatively. In addition, objective acoustic voice analysis was performed using a Multidimensional Voice Program, with Voice Range Profiles and maximum phonation times measured preoperatively and then 1 week, 1 month, 3 months, and 6 months postoperatively. RESULTS Subjective postoperative voice function was significantly better in the robotic group at 1 day, 1 month, and 3 months postoperatively than in the open group. The mean values of fundamental frequency, jitter, shimmer and noise-to-harmonic ratio before and after surgery did not differ between the two groups. However, the frequency range and the highest frequency were significantly better in the robotic group than in the open group at 3 months postoperatively. Subjective swallowing function did not differ between the two groups. CONCLUSION Postoperative voice function is better with robotic thyroidectomy using the GUAB approach than with conventional open thyroidectomy. This is an advantage of robotic thyroidectomy by the GUAB approach in addition to the excellent cosmesis.
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Nam IC, Bae JS, Shim MR, Hwang YS, Kim MS, Sun DI. The Importance of Preoperative Laryngeal Examination Before Thyroidectomy and the Usefulness of a Voice Questionnaire in Screening. World J Surg 2011; 36:303-9. [DOI: 10.1007/s00268-011-1347-5] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Solomon NP, Helou LB, Makashay MJ, Stojadinovic A. Aerodynamic evaluation of the postthyroidectomy voice. J Voice 2011; 26:454-61. [PMID: 21782386 DOI: 10.1016/j.jvoice.2011.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 03/23/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/HYPOTHESES Changes in vocal function before and after thyroidectomy were examined using aerodynamic and related assessments. Laryngeal airway resistance (R(law)) and phonation threshold pressure (PTP) were hypothesized to be sensitive to changes in laryngeal function that may occur after thyroidectomy separate from changes that may occur from endotracheal intubation alone. STUDY DESIGN Prospective longitudinal clinical trial with comparison group. METHODS Eighty patients were evaluated preoperatively, and 2 weeks and 3 months postoperatively to assess voice outcomes after thyroidectomy. In addition, 16 patients who underwent a nonneck operation were tested as a control group. Maximum phonation time (MPT), mean airflow, R(law), and PTP were determined at two vocal fundamental frequency (F0) levels (30% and 80% of the F0 range). RESULTS No systematic differences were detected for MPT, mean airflow, or R(law) as a short-term or intermediate-term outcome of either surgical group. PTP decreased significantly over time for both groups of participants and at both F0 levels. F0 range decreased significantly at the short-term postsurgical assessment and covaried with the PTP results, thereby explaining some of the variability in the PTP data. CONCLUSIONS Aerodynamic assessment did not reveal systematic changes in vocal function associated with thyroidectomy, although PTP decreased postoperatively for both surgical groups. This may be attributable in part to a learning effect or to postoperative reductions in F0 range.
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Affiliation(s)
- Nancy Pearl Solomon
- Department of Surgery, Army Audiology and Speech Center, Walter Reed Army Medical Center, Washington, District of Columbia 20307, USA.
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Serpell JW, Woodruff S, Bailey M, Grodski S, Yeung M. Recurrent Laryngeal Nerve Diameter Increases During Thyroidectomy. Ann Surg Oncol 2011; 18:1742-7. [DOI: 10.1245/s10434-010-1531-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Indexed: 11/18/2022]
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