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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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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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Li SL, Du P, Lv T, Lu DN, Shao CY, Zhang YN, He R, Liu WS, Wang JF, Ren WL, Liang JY, Xu JJ, Ge MH. Quantitative comparison of three thyroidectomy approaches in neck muscles, voice, and swallowing functions. Asian J Surg 2024; 47:1734-1739. [PMID: 38185563 DOI: 10.1016/j.asjsur.2023.12.085] [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: 09/01/2023] [Revised: 11/10/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
OBJECTIVE This study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. METHODS A total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Injury Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. RESULTS The clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). CONCLUSION In comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality.
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Affiliation(s)
- Shi-Lin Li
- Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Pei Du
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Tian Lv
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Dong-Ning Lu
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Cheng-Ying Shao
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yi-Ning Zhang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Ru He
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Wen-Shun Liu
- Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China
| | - Jia-Feng Wang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Department of Thyroid and Breast Surgery, Zhejiang Provincial People's Hospital Bijie Hospital, Bijie, Guizhou, 551700, China
| | - Wei-Li Ren
- Department of Breast and Thyroid Surgery, Shaoxing Shangyu People's Hospital, ShaoxAing, 312300, Shaoxing, Zhejiang, China
| | - Ju-Yong Liang
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China.
| | - Jia-Jie Xu
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China.
| | - Ming-Hua Ge
- Jinzhou Medical University, Jinzhou, Liaoning, 121001, China; Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital, 310014, Hangzhou, Zhejiang, China; Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, 310014, Hangzhou, Zhejiang, China; Clinical Research Center for Cancer of Zhejiang Province, 310014, Hangzhou, Zhejiang, China.
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Carmel Neiderman NN, Arbel S, Diamant N, Wolfman K, Yanko R, Lior Y, Kidron A, Ianculovici C, Kleinman S, Oestreicher-Kedem Y. Direct Transvestibular Feminization Thyroid Laryngochondroplasty. Plast Reconstr Surg 2024; 153:467-476. [PMID: 37075278 DOI: 10.1097/prs.0000000000010560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Feminization laryngochondroplasty (FLC) methods have evolved from using a midcervical incision to a submental, less visible incision. The scar may be unacceptable to the patient because it signals gender reassignment surgery. An endoscopic transoral approach to FLC inspired by transoral endoscopic thyroidectomy was recently suggested to avoid the neck scar; however, it requires special equipment and has a long learning curve. A vestibular incision is used to approach the chin in lower-third facial feminization surgery. The authors propose that this incision may be extended to the thyroid cartilage in performing direct FLCs. The authors describe their experience with a novel, minimally invasive, direct transvestibular use of the chin-reshaping incision. METHODS The medical records of all patients who underwent direct transvestibular FLC (DTV-FLC) from December of 2019 to September of 2021 were retrieved and reviewed for this retrospective cohort study. Data on the operative, postoperative, and follow-up courses, complications, and functional and cosmetic results were retrieved. RESULTS Nine transgender women were included. Seven DTV-FLCs were performed during lower-third facial feminization surgery, and two were isolated DTV-FLCs. One was a revision DTV-FLC. Transient minor complications were encountered and resolved by the postoperative visit at 1 to 2 months. Vocal fold function and voice quality remained intact. Eight available patients were satisfied with the surgical results. A blinded assessment by eight plastic surgeons determined that seven procedures were successful. CONCLUSION The novel DTV-FTLC approach either in isolation or as part of lower-third facial feminization surgery facilitated scar-free FLC with satisfactory cosmetic and functional results. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
| | - Shimrit Arbel
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Noa Diamant
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Karin Wolfman
- Institute for Health and Medical Professions, Ono Academic College
| | | | - Yotam Lior
- Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Sourasky Medical Center, affiliated with School of Medicine, Tel-Aviv University
| | - Anat Kidron
- Division of Anesthesia, Intensive Care and Pain Management, Tel-Aviv Sourasky Medical Center, affiliated with School of Medicine, Tel-Aviv University
| | - Clariel Ianculovici
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Shlomi Kleinman
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
| | - Yael Oestreicher-Kedem
- From the Departments of Otolaryngology, Head and Neck Surgery, and Maxillofacial Surgery
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Zou S, Guo L, Xu C, Liu T, Li L, Pan S, Qi D. Effect of chewing gum of different weights before surgery on sore throat after total thyroidectomy: A randomized controlled trial. World J Surg 2024; 48:130-137. [PMID: 38284756 DOI: 10.1002/wjs.12025] [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: 10/12/2023] [Revised: 10/21/2023] [Accepted: 10/31/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Postoperative sore throat (POST) is a common postoperative complication. COMPLICATION Chewing gum can inhibit the growth of oral bacteria, cleanse, and lubricate the oral cavity, which can help reduce postoperative sore throat. We hypothesize that chewing gum before surgery could relieve POST. METHODS Patients planned to undergo total thyroidectomy under general anesthesia with tracheal intubation were randomized to swallow saliva twice or chew 1.4 g/2.8 g of gum for 2 minutes before surgery. A standard anesthesia protocol was performed. The numerical rating scale scores of POST at 1, 24, and 48 h after surgery were collected. The primary outcome was the incidence of moderate/severe POST (numerical rating scale score >3) within 48 h. RESULTS Data from 148 patients (control group, n = 50; 1.4 g group, n = 48; and 2.8 g group, n = 50) were included in the analysis. Within 48 h, there was a significant difference among the three groups in the incidence of moderate/severe POST (control group: 74% vs. 1.4 g group: 65% vs. 2.8 g group: 50%. P = 0.04). The 2.8 g group had less incidence of moderate/severe POST than the control group (Odds Ratio = 0.351 95% Confidence Interval: (0.152 and 0.814) P = 0.02). CONCLUSION Chewing 2.8 g gum before total thyroidectomy can reduce the incidence of moderate/severe POST within 48 h after surgery.
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Affiliation(s)
- Shiya Zou
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Lulu Guo
- Department of Intensive Care Unit, Xuzhou Center Hospital, Xuzhou, China
| | - Chao Xu
- Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tianyu Liu
- Department of Anesthesiology, Peking University People's Hospital, Beijing, China
| | - Lei Li
- Suzhou Wujiang District Center for Disease Control and Prevention, Suzhou, China
| | - Shoudong Pan
- Department of Anesthesia, Capital Institute of Pediatrics Affiliated Children's Hospital, Beijing, China
| | - Dunyi Qi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Peking, China
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Chen Z, Guo Y, Huo J, Hu X, Chen C, Gao D, Yang L, Wang C, Qu R. Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Influences on the Voice Changes and Swallowing Function Disorders. Surg Laparosc Endosc Percutan Tech 2023; 33:587-591. [PMID: 37852216 DOI: 10.1097/sle.0000000000001238] [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: 01/05/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the influence of transoral endoscopic thyroidectomy vestibular approach (TOETVA) on voice changes and swallowing function disorders. MATERIALS AND METHODS We retrospectively reviewed 215 patients who underwent thyroid surgery with TOETVA (105 cases, endoscopic group) and open approach (110 cases, open group). Major outcomes, the changes in voice and swallowing function in the 2 groups of patients before and after surgery were analyzed by using both subjective and objective evaluation indexes. Subjective evaluation indexes included the Voice Handicap Index, voice GRBAS (Grade, Roughness, Breathiness, Asthenia, Strain) classification, and swallowing impairment score; the objective indicators included the fundamental frequency (F0), fundamental frequency perturbation (jitter), amplitude perturbation (shimmer), and maximum phonation time. RESULTS In terms of subjective evaluation indexes, there were no significant differences (all P> 0.05) between the groups regarding Voice Handicap Index (1 and 3 mo after surgery) and GRBAS (1 and 3 mo after surgery). The incidence rates of swallowing disorder in the endoscopic group were higher than that in the open group according to the outcomes of swallowing impairment score at 1 and 3 months after surgery (both P< 0.05). In addition, no significant changes in terms of jitter, shimmer, and maximum phonation time in both groups of patients at 1 and 3 months after surgery compared with their preoperative values (all P> 0.05). CONCLUSIONS Voice and swallowing disorders may occur in some patients, either TOETVA or open thyroid surgery, which in most cases will recover within 3 months after surgery. The time to swallowing function recovery is relatively prolonged in patients following TOETVA, which may be probably associated with neck adhesion and fixation after the operation.
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Affiliation(s)
- Zongyi Chen
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Youming Guo
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Jinlong Huo
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Xiaochi Hu
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Chen Chen
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Dan Gao
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Li Yang
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Cunchuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rui Qu
- Department of Thyroid Surgery, First People's Hospital of Zunyi/Third Affiliated Hospital of Zunyi Medical University, Zunyi
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Qin X, Luo J, Ma J, Cao X, Zhao J, Jiang J, Zhang Y, Zeng L, Fan L. Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery. Int J Surg 2023; 109:3974-3982. [PMID: 37755372 PMCID: PMC10720820 DOI: 10.1097/js9.0000000000000725] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVE To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL). SUMMARY BACKGROUND DATA Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons. METHODS We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)]. RESULTS The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups. CONCLUSIONS RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.
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Affiliation(s)
| | | | | | | | | | | | | | - Lingjuan Zeng
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
| | - Linjun Fan
- Department of Breast and Thyroid Surgery, Southwest Hospital, the First Affiliated Hospital of the Army Military Medical University, Gaotanyan Street 29, Shapingba District, Chongqing, 400038, China
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Sõber L, Lepner U, Kirsimägi Ü, Kasenõmm P. Prethyroidectomy voice and swallowing disorders and the possible role of laryngopharyngeal reflux disease. LOGOP PHONIATR VOCO 2023; 48:111-116. [PMID: 34939908 DOI: 10.1080/14015439.2021.2020894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/16/2021] [Accepted: 12/16/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate voice and swallowing function before thyroid surgery and to explore the possible role of thyroid enlargement and laryngopharyngeal reflux (LPR). METHODS We conducted a prospective study of patients who underwent hemi- or total thyroidectomy (n = 118) and compared the results with patients of laparoscopic cholecystectomy (n = 110). All subjects underwent videolaryngostroboscopy, filled in subjective evaluations of voice, swallowing and reflux complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) and perceptual voice evaluation were conducted. RESULTS We found no difference in voice quality between study and control group, neither in subjective complaints nor in AVA or perceptual evaluation. We did find indicative signs of minor laryngeal changes in thyroid group. Swallowing Impairment Score (SIS) revealed worse swallowing function in thyroid patients (p = 0.0006). Comparison of Reflux Symptom Index (RSI) scores revealed that thyroid group patients have higher values compared to control group (p = 0.006). Nevertheless, Reflux Finding Score (RFS) showed identical scores in both groups (p = 0.220). In thyroid group there was a strong positive correlation between RSI and SIS (ρ = 0.641), but no correlation between RFS and SIS (ρ = -0.002). In addition, we found a weak positive correlation between thyroid weight and RFS (ρ = 0.379). CONCLUSIONS Changes in laryngeal area caused by thyroid disorders do not lead to subjective but indicate slight objective disturbances in voice quality. We detected a decline in swallowing quality within thyroid patients. Higher RSI scores and a positive correlation between RFS and thyroid weight, indicate a possible role of thyroid gland in LPR.
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Affiliation(s)
- Linda Sõber
- ENT Clinic, Tartu University Hospital, Tartu, Estonia
| | - Urmas Lepner
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ülle Kirsimägi
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
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Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y, Zhu F, Zhu L, Chen L, Pan J, Du Y, Yan X, Zhang Q, Zhou X, Tian W, Wu Y. Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial. Int J Surg 2023; 109:2672-2679. [PMID: 37379168 PMCID: PMC10498877 DOI: 10.1097/js9.0000000000000505] [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: 08/29/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.
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Affiliation(s)
- Linghui Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qiwen He
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hedi Tian
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qinsheng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yibin Shen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yun Fang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Feng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lixian Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Liang Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jun Pan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yehui Du
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaochuan Yan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qijun Zhang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xueyu Zhou
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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10
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Chawaka HJ, Teshome ZB. The Underreported Postoperative Suffering after Thyroid Surgery: Dysphagia, Dysphonia, and Neck Pain-A Cross-Sectional Study. Anesthesiol Res Pract 2023; 2023:1312980. [PMID: 37583794 PMCID: PMC10425250 DOI: 10.1155/2023/1312980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/25/2022] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
Background and Aims Postoperative voice change, difficulty of swallowing, throat pain, and neck pain are the most commonly complaint after thyroid surgery. However, little emphasis is given to the problem, especially a place where the surgical and anesthesia services' unmet need is highly observed, i.e., the problem gets little attention especially in the countries where the gaps of surgery and anesthesia services are observed. Hence, this study aims to determine the magnitude and associated factors of voice change and related complaints after thyroid surgery. Methods A cross-sectional study was conducted on 151 patients who had had thyroid surgery from June 1 to December 30, 2021. Data were retrieved during the postoperative period after the patient regains consciousness. Result Out of 151 participants, 98 (64.9%) patients complained of either voice change or difficulty of swallowing and neck pain after thyroid surgery within 24 hours. Majority (58.3%) of the participants aged more than 30 years with a mean age of 33.7 ± 8.3 years and females 102 (67.5%). Neck pain is the most (52.3%) complained suffering after thyroid surgery, followed by voice change 38.4% and difficulty in swallowing 37.7%. Difficulty in swallowing after thyroid surgery significantly associated with a patient who frequently experience intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p = 0.01), type of surgical procedure (total thyroidectomy) (AOR = 8.62, 95% CI 1.21-61.50, and p = 0.03), and larger ETT size (AOR = 4.92, 95% CI 1.34-18.01, and p = 0.02). Postoperative voice change is associated with larger endotracheal tube (AOR = 15.47, 95% CI 3.4-69.5, and p ≤ 0.001), surgery lasting more than 2 hours (AOR = 7.34, 95% CI 1.5-35.1, and p = 0.01), and intraoperative hypotension (AOR = 23.24, 95% CI 4.6-116.7, and p ≤ 0.001). Conclusion The complaint of postthyroidectomy neck pain and throat discomfort is higher than 64.9%. Intraoperative hypotension, blood loss, higher ETT size utilization, and duration of surgical procedure are the identified possible risk factors and have to be minimized as much as possible. Patient reassurance has to be considered during the postoperative time.
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11
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Chiu A, Damico C, Bach K, Arroyo N, Sippel R, Francis DO. Longitudinal experience of patients with post-thyroidectomy vocal cord paralysis. Am J Surg 2023; 225:685-689. [PMID: 36257853 DOI: 10.1016/j.amjsurg.2022.10.005] [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: 07/28/2022] [Revised: 09/16/2022] [Accepted: 10/05/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Prior studies of post-thyroidectomy vocal cord paralysis (VCP) present static and limited evaluations. We comprehensively assessed the experience of patients with VCP post-thyroidectomy over 1 year. METHODS Voice Handicap Index (VHI), Eating Assessment Tool (EAT-10), 12-Item Short Form Survey (SF-12), and qualitative interviews were assessed preoperatively, and 2-weeks, 6-weeks, 6-months, and 1-year postoperatively. OUTCOMES 7 of 44 patients (15.9%) had postoperative VCP. Compared to those without complication, mean VHI scores for VCP patients increased significantly from baseline at 2-weeks (27.9 point increase vs 1.6, p < 0.01) and 6-weeks (26.3 vs. -0.3, p < 0.01) postoperative. There were no significant differences between groups in SF-12 or EAT-10 scores at any point. Qualitative interviews showed that both groups noted bothersome voice symptoms at 2-weeks; however, by 6-weeks, only VCP patients noted voice symptoms negatively affecting their life. CONCLUSION While both patients with and without VCP reported subjective voice symptoms immediately postoperatively, those with VCP had worse quantitative measures. Understanding the longitudinal experience of VCP can help providers tailor counseling for these patients.
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Affiliation(s)
- Alexander Chiu
- Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | - Cara Damico
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Kathy Bach
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Natalia Arroyo
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Rebecca Sippel
- Department of Surgery, Section of Endocrine Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David O Francis
- Department of Surgery, Wisconsin Surgical Outcomes Research Program, University of Wisconsin-Madison, Madison, WI, USA; Department of Surgery, Division of Otolaryngology, University of Wisconsin-Madison, Madison, WI, USA
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12
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Wang X, Zhu G, Tan J, Cao X, Duan M. Effects of continuous and slow tracheal tube cuff deflation on cough reflex during extubation in noncardiac surgery patients: a randomised clinical trial. BMC Anesthesiol 2023; 23:45. [PMID: 36750765 PMCID: PMC9903553 DOI: 10.1186/s12871-023-02003-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The incidence of cough reflex during extubation is 76%. Cough reflex causes severe hemodynamic fluctuations and airway complications. This prospective trial investigated the potential effects of tracheal tube cuff deflation on cough reflex during extubation. METHODS One hundred and twenty-six patients scheduled for operations within 3 h under general anaesthesia with orotracheal intubation were randomly assigned to one of three groups: control (C), experimental (E) or syringe (S) groups. Patients in group C underwent tracheal tube cuff deflation using a 10-ml syringe in 1 s, patients in group E underwent tracheal tube cuff deflation continuously and slowly in 5 s using a cuff pressure gauge until the pressure was zero and patients in group S underwent tracheal tube cuff deflation using a 10-ml syringe at a speed of 1 ml s-1. The incidence and severity of cough reflexs during extubation and the incidence of postoperative airway complications within 48 h were assessed. RESULTS Compared with group C (60.0%), the incidence of cough reflex in group E was 9.8% (p < 0.001) and in group S was 12.5% (p < 0.001). The severity of cough reflex was graded as 2 (1-2) in group C, 1 (1-1) in group E and 1 (1-1) in group S (p < 0.001 for group comparisons). The incidence of hoarseness in group C was 0.0%, in group E was 19.5% and in group S was 5.0% (p < 0.05 for all groups, p = 0.009 between group C and E). CONCLUSIONS Compared with deflating a trachal tube cuff with a 10-ml syringe in 1 s, the use of a 10-ml syringe at a speed of 1 ml s-1 or a cuff pressure guage within 5 s can both reduce the incidence of cough reflex, but deflating with a cuff pressure guage can increase the incidence of postoperative hoarseness. TRIAL REGISTRATION Chinese Clinical Trial Registry, identifier: ChiCTR2100054089, Date: 08/12/2021.
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Affiliation(s)
- Xuan Wang
- grid.89957.3a0000 0000 9255 8984Department of Anesthesiology, Benq medical center & Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, No. 71 Hexi Avenue, Jianye District, Jiangsu Province 210019 Nanjing, People’s Republic of China
| | - Guangli Zhu
- grid.417303.20000 0000 9927 0537Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province People’s Republic of China
| | - Jing Tan
- grid.452509.f0000 0004 1764 4566Department of Anesthesiology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, Jiangsu Province People’s Republic of China
| | - Xinyu Cao
- grid.417303.20000 0000 9927 0537Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province People’s Republic of China
| | - Manlin Duan
- Department of Anesthesiology, Benq medical center & Jinling Hospital, Jinling School of Clinical Medicine, Nanjing Medical University, No. 71 Hexi Avenue, Jianye District, Jiangsu Province, 210019, Nanjing, People's Republic of China. .,Jiangsu Provincial Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu Province, People's Republic of China.
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13
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Melfa G, Siragusa G, Cocorullo G, Guzzino M, Raspanti C, Albanese L, Mazzola S, Richiusa P, Orlando G, Scerrino G. Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study. J Clin Med 2022; 12:jcm12010305. [PMID: 36615105 PMCID: PMC9821617 DOI: 10.3390/jcm12010305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Voice and swallowing problems are frequently associated with thyroidectomy. Intermittent nerve monitoring (i-IONM) seems to provide a positive effect in reducing its prevalence. The aim of this study was to test the hypothesis that continuous intraoperative nerve monitoring (c-IONM) may reduce the prevalence of these disorders even further than i-IONM. Methods: This 3-arm prospective bi-institutional study compared 179 consecutive patients that underwent thyroidectomy: 56 without IONM, 55 with i-IONM and 67 with c-IONM. Neck dissections and laryngeal nerve palsies were excluded. Two questionnaires (VHI-10 for voice disorders and EAT-10 for swallowing disorders; both validated for Italian language use) were administered before and 1 month after surgery. Statistical significance was analyzed by the chi-squared test. Results: After thyroidectomy, no statistically significant differences were found in the three groups concerning EAT-10. although these symptoms seemed to be influenced by gastro-esophageal reflux. VHI-10 worsened in the “no-IONM” group compared with both i-IONM (p < 0.09, not quite statistically significant) and c-IONM (p < 0.04). Conclusion: Both i- and c-IONM improve voice quality independently of laryngeal nerve integrity. Reduced dissection and particularly restrained manipulation could explain these results, being particularly favorable for c-IONM.
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Affiliation(s)
- Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | | | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Marianna Guzzino
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Cristina Raspanti
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Leone Albanese
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Pierina Richiusa
- Section of Endocrinology—Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
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Kaur J, Singh G, Davessar JL, Bhatia R. Impact of Thyroid surgery on Voice: A prospective study. Indian J Otolaryngol Head Neck Surg 2022; 74:5094-5097. [PMID: 36742723 PMCID: PMC9895169 DOI: 10.1007/s12070-021-02787-3] [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: 04/13/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023] Open
Abstract
Thyroidectomy is one of the most common neck surgery done worldwide. It is associated with debilitating post-operative voice changes even without recurrent laryngeal nerve (RLN) injury. Aims and Objectives: To study the impact of thyroidectomy on voice parameters in the absence of Recurrent Laryngeal Nerve and External Branch of Superior Laryngeal Nerve injury and comparison between the pre and post-operative changes in the subjective and objective voice parameters. Methodology: Patients fulfilling the inclusion criteria underwent thyroidectomy. The Subjective voice assessment was done using Voice Impairment Score (VIS) and objective parameters were analyzed using Multi-Dimensional Voice Program (MDVP) pre-operatively and post-operatively at 1 week, 1 month and 3 months interval. Results: On MDVP analysis of patients, a fall in Mean F0 (Hz), Minimum F0 (Hz) and Maximum F0 (Hz) values was noted at 1 week after surgery. But a trend toward the pre-operative values was observed at 3 months post-operatively.
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Affiliation(s)
- Jasmine Kaur
- Department of Otorhinolaryngology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Gurbax Singh
- Department of Otorhinolaryngology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Jai Lal Davessar
- Department of Otorhinolaryngology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | - Rupali Bhatia
- Department of Preventive and Social Medicine, Guru Gobind Singh Medical College and Hospital, Faridkot, India
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15
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The Impact of Post-Thyroidectomy Neck Stretching Exercises on Neck Discomfort, Pressure Symptoms, Voice and Quality of Life: A Randomized Controlled Trial. World J Surg 2022; 46:2212-2222. [PMID: 35637354 PMCID: PMC9150879 DOI: 10.1007/s00268-022-06610-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
Abstract
Background Methods Results Conclusions
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16
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Mari G, Marchese MR, Longobardi Y, Proietti I, Marenda ME, Di Cesare T, D'Alatri L. Voice Telerehabilitation in Iatrogenic Unilateral Vocal Fold Paralysis: From Necessity to Opportunity in the COVID-19 Time. J Voice 2022:S0892-1997(22)00108-4. [PMID: 35641380 DOI: 10.1016/j.jvoice.2022.04.005] [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: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate results of telerehabilitation (TR) during the coronavirus disease 2019 pandemic for the treatment of dysphonia caused by permanent post-thyroidectomy unilateral vocal fold paralysis (UVFP). METHODS Forty subjects with post-thyroidectomy UVFP (onset <1 month) underwent TR. Videostrobolaryngoscopy, acoustic and perceptual voice analysis and patient self-assessment were carried out in person before, at the end of TR and 6 months later. RESULTS Twenty-five subjects spontaneously recovered full vocal fold motility at some time during follow-up, whereas 15 had a permanent UVFP at the end of the follow-up period. These subjects constituted our study group. At the early posttherapy control 10/15 subjects (66.6%) showed a complete glottal closure, while in 5/15 (33.3%) a glottal gap remained (P = 0.03). These results did not change 6 months after TR. At the late posttherapy control the maximum phonation time improved significantly (P = 0.02). Both post-therapy Voice Handicap Index scores were significantly lower than the pre-therapy ones (P = 0.04). Grade, Breathiness, and Asthenia parameters of the Grade-Roughness-Breathiness-Asthenia-Strain scale improved 6 months after TR (P < 0.05). The number of voice signals suitable for acoustic analysis increased significantly after therapy. Finally, 87% of patients were satisfied with TR. CONCLUSIONS With careful patient selection, TR may be considered as a promising method for voice therapy in postthyroidectomy UVFP.
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Affiliation(s)
- Giorgia Mari
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Raffaella Marchese
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia.
| | - Ylenia Longobardi
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Ilaria Proietti
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Maria Elisabetta Marenda
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia
| | - Tiziana Di Cesare
- Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
| | - Lucia D'Alatri
- Unità Operativa Complessa di Otorinolaringoiatria, Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italia; Sezione di Otorinolaringoiatria, Dipartimento Universitario Testa-Collo e Organi di Senso, Università Cattolica del Sacro Cuore, Roma, Italia
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17
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Gangner Y, Bagot d'Arc M, Delin C. The use of self-assembling peptides (PuraStat) for hemostasis in cervical endocrine surgery. A real-life case series of 353 patients. Int J Surg Case Rep 2022; 94:107072. [PMID: 35452943 PMCID: PMC9043638 DOI: 10.1016/j.ijscr.2022.107072] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/08/2022] [Indexed: 11/26/2022] Open
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18
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Sõber L, Lepner U, Kirsimägi Ü, Puksa L, Kasenõmm P. Voice and Swallowing Disorders After Thyroid Surgery. J Voice 2022:S0892-1997(22)00077-7. [PMID: 35410778 DOI: 10.1016/j.jvoice.2022.03.013] [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: 12/26/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate voice and swallowing function following thyroid surgery, to identify dynamic changes during the follow-up period of 12-18 month and to find possible indicative signs of permanent or temporary vocal fold palsy. METHODS All participants (N = 110) were prospectively enrolled from the preoperative thyroid surgery patients between September 2013 and December 2016. All subjects underwent preoperatively, first week and 12-18 month postoperatively videolaryngostroboscopy, filled in subjective evaluation of voice (voice handicap index, [VHI]) and swallowing (swallowing impairment score) complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) measurement and perceptual voice evaluation were conducted. In the presence of laryngeal damage, additional first and sixth-month follow-up visits were planned. Patients, whom we suspected laryngeal nerve damage, underwent laryngeal electromyography 4 weeks after the operation. RESULTS On first postoperative week evaluation, no objective voice changes within patients with postoperatively intact laryngeal nerves were found. Subjective evaluations showed decline in VHI physical domain and increased strain in postoperative voice. Patients with postoperative nerve damage had a drastic decline in subjective voice quality (VHI all subscales and total score), AVA parameter jitter, MPT and perceptual voice quality. Subjective evaluation of swallowing revealed disturbances in all patients regardless of the nerve damage. We noticed remarkable differences in first week and first month visits between patients with permanent and temporary palsy in VHI total score and physical domain, MPT and perceptual breathiness and asthenia in voice. Regardless of the nerve injury, by the end of the follow-up period all changes had become statistically insignificant with the exception of perceptual evaluation of voice quality. CONCLUSIONS Patients with postoperative laryngeal nerve damage experience substantial deterioration of both subjective and objective voice quality with more extensive impairment in patients with permanent paralysis. Thyroid surgery causes subjective swallowing changes irrespective of laryngeal nerve damage. In patients without laryngeal nerve damage, swallowing function improves following thyroidectomy. Possible indicators for permanent paralysis are delayed recovery in the values of MPT and jitter and persistent perceptual breathiness and asthenia.
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Affiliation(s)
- L Sõber
- ENT Clinic, Tartu University Hospital, Tartu, Estonia.
| | - U Lepner
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - Ü Kirsimägi
- Surgery Clinic, Tartu University Hospital, Tartu, Estonia
| | - L Puksa
- Sports Medicine and Rehabilitation Center, Tartu University Hospital, Tartu, Estonia
| | - P Kasenõmm
- ENT Clinic, Tartu University Hospital, Tartu, Estonia
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Jiang B, Qu C, Jiang C, Zhang C, Shen S, Luo Y, Su L. Comparison of Supraclavicular Oblique Incision With Traditional Low Collar Incision Approach for Thyroidectomy in Differentiated Thyroid Cancer. Front Oncol 2022; 12:842981. [PMID: 35372045 PMCID: PMC8964930 DOI: 10.3389/fonc.2022.842981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/09/2022] [Indexed: 12/29/2022] Open
Abstract
Background Various incisions and approaches for thyroidectomy have been developed to treat differentiated thyroid cancer (DTC). Supraclavicular oblique incision (SOI) thyroidectomy (SOIT) has been applied in DTC patients over the past ten years. However, the safety and efficacy of this approach were yet to be confirmed. Aim This study aimed to compare the surgical and patient-related outcomes between SOIT and traditional low collar incision thyroidectomy (TLCIT) in patients with DTC. Methods We retrospectively screened all patients with DTC who received thyroid lobectomy from October 2020 to October 2021. The surgical results and patient-related outcomes assessed at 1 and 6 months after surgery by questionnaire were compared between the SOIT and TLCIT groups. Results A total of 128 patients were included in this study, of whom 38 patients (30.5%) were operated on with SOIT and 89 patients (69.5%) with TLCIT. There was no significant difference in demographic characteristics and thyroid features between the two groups. Despite comparable operative time (61.9 ± 12.1 vs. 59.9 ± 15.0 min, p = 0.425), the SOIT group had a smaller neck incision (4.4 ± 0.7 vs. 5.0 ± 1.0 cm, p = 0.002), a shorter duration of postoperative drainage (2.4 ± 0.5 vs. 2.7 ± 0.9 days, p = 0.019), less volume of postoperative drainage (48.4 ± 24.6 vs. 60.3 ± 22.8 ml, p = 0.040), and shorter postoperative hospitalization (3.2 ± 0.5 vs. 3.6 ± 0.9 days p = 0.006), as compared with the TLCIT group. At 1-month follow-up after surgery, SOIT showed better performance in preventing hypoparathyroidism (p = 0.026) and abnormal neck sensation (p = 0.010) and in improving cosmetic satisfaction (p = 0.036) than TLCIT. At 6-month follow-up, SOIT was feedback with better cosmetic satisfaction (p < 0.001) and a lower percent of abnormal neck sensation (p = 0.031) or movement (p = 0.005). Conclusion Our study suggests that minimally invasive surgery using the SOI provides superior surgical and patient-related outcomes compared with surgery using a traditional low collar incision (TLCI) in patients with DTC.
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Affiliation(s)
- Bo Jiang
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China
| | - Cheng Qu
- Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chaoyu Jiang
- Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Chen Zhang
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Song Shen
- Department of Cardiology, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yuqian Luo
- Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Lei Su
- Department of General Surgery, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.,Department of General Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
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Taito M, Hamamoto T, Chikuie N, Nishida M, Takeno S, Okamura H. Association between subjective voice Assessment and psychological distress after thyroidectomy. J Perianesth Nurs 2022; 37:260-263. [DOI: 10.1016/j.jopan.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/21/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
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21
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Wu Y, Zhu F, Shen Y, Fang Y, Zhu L, He Q, Pan J, Chen L, Tian W. The steps and key points of thyroid surgery with lateral cervical incision. Zhejiang Da Xue Xue Bao Yi Xue Ban 2021; 50:701-706. [PMID: 35347918 PMCID: PMC8931620 DOI: 10.3724/zdxbyxb-2021-0341] [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: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
The thyroid surgery with lateral cervical incision uses the sternocleidomastoid intermuscular approach through the gap between band muscles and carotid sheath to reach the surgical field. The recurrent laryngeal nerve and upper and lower parathyroid glands are first identified, the upper pole vessels are severed; then the Berry ligament is separated; the isthmus is severed, and the thyroid gland is finally removed. This approach can avoid the trauma of the skin and muscle tissue in the anterior neck region, to relieve the pressure on the neck and swallowing stretch feeling for patients after surgery. The surgical modality is effective and less time-consuming. This article gives a detailed introduction to the standardized procedures and some key points of thyroid surgery with lateral cervical incision.
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Affiliation(s)
- Yijun Wu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Feng Zhu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yibin Shen
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yun Fang
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lixian Zhu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qiwen He
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jun Pan
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Linghui Chen
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wen Tian
- of Thyroid and Hernia Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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22
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Huang TY, Yu WHV, Chiang FY, Wu CW, Fu SC, Tai AS, Lin YC, Tseng HY, Lee KW, Lin SH. How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice. Cancers (Basel) 2021; 13:cancers13215379. [PMID: 34771543 PMCID: PMC8582531 DOI: 10.3390/cancers13215379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Recurrent laryngeal nerve (RLN) dysfunction remains a major source of morbidity after thyroid surgery. Intraoperative neuromonitoring can qualify and quantify RLN function according to the laryngeal electromyography (EMG) response evoked by electrical stimulation of the RLN. To the best of our knowledge, this is the first report to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who have received monitored thyroidectomy. For optimal voice and swallowing outcomes after thyroid surgery, thermal injury must be avoided, especially when using energy-based devices, and mechanical injury must be identified early to avoid a more severe dysfunction. Adherence to standard intraoperative neuromonitoring (IONM) procedures for thyroid surgery is suggested, including standard procedures for acquiring and interpreting intraoperative RLN signals, for identifying and classifying RLN injury mechanisms, for performing laryngeal examinations and comprehensive voice assessments (subjective and objective voice analysis) before and after surgery, and for performing standard follow-up procedures. Abstract Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.
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Affiliation(s)
- Tzu-Yen Huang
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Wing-Hei Viola Yu
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
| | - Feng-Yu Chiang
- Department of Otolaryngology—Head and Neck Surgery, E-Da Hospital, Kaohsiung 824, Taiwan;
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 824, Taiwan
| | - Che-Wei Wu
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
- Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Shih-Chen Fu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan; (S.-C.F.); (A.-S.T.)
| | - An-Shun Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan; (S.-C.F.); (A.-S.T.)
| | - Yi-Chu Lin
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
| | - Hsin-Yi Tseng
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
| | - Ka-Wo Lee
- International Thyroid Surgery Center, Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan; (T.-Y.H.); (W.-H.V.Y.); (C.-W.W.); (Y.-C.L.); (H.-Y.T.); (K.-W.L.)
- Department of Otolaryngology—Head and Neck Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 801, Taiwan
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan; (S.-C.F.); (A.-S.T.)
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Correspondence: ; Tel.: +886-(3)-5712121 (ext. 56822)
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23
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Yu HW, Lee D, Lee K, Kim SJ, Chai YJ, Kim HC, Choi JY, Lee KE. Effect of an anti-adhesion agent on vision-based assessment of cervical adhesions after thyroid surgery: randomized, placebo-controlled trial. Sci Rep 2021; 11:19935. [PMID: 34620907 PMCID: PMC8497539 DOI: 10.1038/s41598-021-97919-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Many patients experience cervical adhesions after thyroid surgery. To date, however, no studies have objectively measured the effects of anti-adhesion agents on cervical adhesion symptoms. This study evaluated the effects of an anti-adhesion agent on cervical adhesions after thyroid surgery, as determined using a system that measures the extent of marker movement objectively. One hundred patients were randomized in a 1:1 ratio to undergo thyroid surgery with or without the anti-adhesion agent Collabarrier. Using specially manufactured recording equipment, the position of the marker on neck skin was measured before surgery, and 2 weeks, 3 months, and 9 months after surgery. Relative change in marker distance, calculated by subtracting the marker position before surgery from the marker positions 2 weeks, 3 months, and 9 months after surgery, differed significantly in the groups of patients who underwent thyroid surgery with and without the anti-adhesion agent (P < 0.05). A novel measuring system can objectively evaluate the effectiveness of a thyroid anti-adhesion agent. The anti-adhesion agent used significantly reduced adhesions compared with the control group. The trial is registered at www.cris.nih.go.kr (KCT0005745; date of registration, 08/01/2021).
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Affiliation(s)
- Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Dongheon Lee
- Department of Biomedical Engineering, Chungnam National University College of Medicine and Hospital, Daejeon, Korea
| | - Keunchul Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea
| | - Su-Jin Kim
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Hee Chan Kim
- Department of Biomedical Engineering and Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University College of Medicine and Hospital, Seoul, Korea
| | - June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si, Korea.
| | - Kyu Eun Lee
- Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Korea
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24
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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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25
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Ryu CH, Lee SJ, Cho JG, Choi IJ, Choi YS, Hong YT, Jung SY, Kim JW, Lee DY, Lee DK, Lee SJ, Lee YC, Lee YS, Nam IC, Park KN, Park YM, Sung ES, Son HY, Seo IH, Lee BJ, Lim JY. Care and Management of Voice Change for Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline. Clin Exp Otorhinolaryngol 2021; 15:24-48. [PMID: 34098629 PMCID: PMC8901944 DOI: 10.21053/ceo.2021.00633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/31/2021] [Indexed: 11/22/2022] Open
Abstract
Voice change is a common complaint after thyroid surgery and has significant impacts on quality of life. The Korean Society of Laryngology, Phoniatrics, and Logopedics set up a task force team to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations include preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, including in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQ) in three categories: preoperative (KQ1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. Detailed evidence profiles are presented for each recommendation. The level of evidence for each recommendation is classified into high, moderate, and low-quality. The recommendation's strengths are adjusted to consider the level of evidence resulting in the recommendation and are divided into strong and weak. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.
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Affiliation(s)
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Seung Jin Lee
- Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea
| | - Jae-Gu Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological Medical Sciences, Seoul, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Yeungnam University, College of Medicine, Daegu, Korea
| | - Yong Tae Hong
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Jeonbuk National University Hospital, Jeonju, Korea
| | - Soo Yeon Jung
- Department of Otorhinolaryngology Head and Neck Surgery, Ewha Womans University, College of Medicine, Seoul, Korea
| | - Ji Won Kim
- Department of Otorhinolaryngology Head and Neck Surgery, Inha University, College of Medicine, Incheon, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University, College of Medicine, Seoul, Korea
| | - Dong Kun Lee
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, Dong-A University, Busan, Korea
| | - Sang Joon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Dankook University, College of Medicine, Cheonan, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Yong Sang Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Inn Chul Nam
- Department of Otorhinolaryngology Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Seoul, Korea
| | - Ki Nam Park
- Department of Otorhinolaryngology Head and Neck Surgery, Soonchunhyang University, College of Medicine, Bucheon, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Suk Sung
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Hee Young Son
- Department of Otorhinolaryngology Head and Neck Surgery, Dongnam Institute Of Radiological & Medical Sciences, Busan, Korea
| | - In Hyo Seo
- Voice & Speech Clinic, College of Medicine, Dankook University, Cheonan, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
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26
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Park JS, Frank E, Simental A, Perez HA, Park JJ, Filho PA, Murry T. Incidence of Dysphonia and Dysphagia Exceeds Recurrent Laryngeal Nerve Injury During Thyroid Surgery. J Voice 2021:S0892-1997(21)00093-X. [PMID: 34053823 DOI: 10.1016/j.jvoice.2021.02.030] [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: 12/21/2020] [Revised: 02/18/2021] [Accepted: 02/22/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To determine the prevalence of separate and combined voice and swallowing impairments before and after total thyroidectomy and to delineate risk factors for these symptoms. METHODS Retrospective review of 592 consecutive patients who underwent total thyroidectomy from July 2003 to August 2015. RESULTS Combined voice and swallowing problems occurred preoperatively in 4.7% (11/234), 3.3% (3/92), and 6.0% (16/266) of patients with malignancy, hyperthyroidism, and benign euthyroid disease, respectively. Postoperatively, prevalence was 5.1%, 2.2%, and 1.9%, respectively. Benign euthyroid disease (20.7%) had the greatest risk of preoperative dysphagia (P = 0.003) and the largest glands (P < 0.001). Comparing before and after surgery, the cancer and benign euthyroid groups had decreased dysphagia (cancer: 11.5% vs. 6.0%, P = 0.034; benign: 20.7% vs. 3.8%, P < 0.001) but increased dysphonia (cancer: 19.2% vs. 28.6%, P = 0.017; benign: 15.8% vs. 27.1%, P = 0.002). Overall, 23/592 (3.9%) developed new dysphagia and 122/592 (20.6%) developed new dysphonia after surgery. Intraoperative recurrent laryngeal nerve transection occurred in 12 cases (2.0%). CONCLUSIONS Total thyroidectomy resolved dysphagia but increased dysphonia in benign and malignant euthyroid patients. Voice and swallowing problems following thyroidectomy occurred more frequently than intraoperative recurrent laryngeal nerve transection, confirming symptoms often occur in the absence of suspected nerve injury.
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Affiliation(s)
- Joshua S Park
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California.
| | - Ethan Frank
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Alfred Simental
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Hector A Perez
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Jaimie J Park
- Loma Linda University School of Medicine, Loma Linda, California
| | - Pedro Andrade Filho
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
| | - Thomas Murry
- Loma Linda University Health, Department of Otolaryngology, Loma Linda, California
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27
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Kim SY, Kim GJ, Lee DH, Bae JS, Lee SH, Kim JS, Hwang YS, Shim MR, Park YH, Sun DI. Analysis of voice changes after thyroidectomy using the thyroidectomy-related voice and symptom questionnaire. Auris Nasus Larynx 2021; 48:963-972. [PMID: 33896674 DOI: 10.1016/j.anl.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 03/01/2021] [Accepted: 03/25/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE After thyroidectomy, many patients suffer from voice problems and vague neck discomfort. The Thyroidectomy-related Voice and Symptom Questionnaire (TVSQ) is a self-administered questionnaire used to evaluate pre- and post-operative vocal status as well as throat and neck discomfort. We investigated voice conditions in thyroidectomy patients using the TVSQ as well as correlations between TVSQ responses and objective voice parameters. Also, we examined whether any clinicopathologic or surgical factors affect phonetic change after thyroidectomy. METHODS We retrospectively reviewed the records of 242 patients who underwent total thyroidectomy to treat papillary carcinoma between January to December of 2019. Of these, we enrolled 232 who exhibited normal vocal cord mobility after surgery. TVSQ responses and acoustic voice analysis results were examined preoperatively and at 1, 3, and 6 months postoperatively. We subclassified patients into favorable and unfavorable TVSQ groups based on the increase in TVSQ score (△TVSQ ≥20) at 1 month postoperatively. We then investigated the difference of acoustic characteristics between two groups and analyzed the correlations between acoustic parameters and various clinical and surgical factors including pathologic results and lymph node status by subgroup. RESULT All acoustic voice parameters except for the noise-to-harmonics ratio were significantly worse at 1 month postoperatively and recovered over time, but the TVSQ score did not recover from the 1-month value until 6 months postoperatively. In the subgroups, among the many clinicopathologic factors examined, advanced N stage (p = 0.002) and high positive total and central-and-lateral-neck lymph node ratios were significantly associated with an increased risk of an unfavorable TVSQ (p = 0.049, 0.027, <0.01, respectively). Among the acoustic parameters, only the changes in TVSQ total score and voice score were correlated with deterioration in jitter and shimmer at 1 month postoperatively. However, the correlations was not statistically significant and had disappeared at 6 months postoperatively. CONCLUSION We figured out that TVSQ was able to capture the negative effects of lymph node status and lymph node dissection on vocal outcomes after thyroidectomy. Although there was a weak correlation between worsened perturbation value and TVSQ changes, no other acoustic analysis parameters were statistically significant correlated with the TVSQ score.
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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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28
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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA): Surgical Outcomes and Learning Curve. J Clin Med 2021; 10:jcm10040863. [PMID: 33669741 PMCID: PMC7922263 DOI: 10.3390/jcm10040863] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/14/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Abstract
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) has excellent cosmetic effects and its popularity is increasing worldwide. We present our experience with TOETVA and its short-term outcomes. This study included 110 consecutive patients who underwent TOETVA at a single institution between July 2016 and June 2020. We analyzed clinicopathologic data, short-term postoperative outcomes, and learning curve using cumulative summation (CUSUM) analysis. Of the 110 patients who underwent TOETVA, 101 had malignant disease and 100 (90.9%) underwent lobectomy. The mean age was 39.7 ± 9.7 years, and the mean tumor size was 1.0 ± 0.7 cm (range, 0.3–3.6 cm). Operation time was 168.0 ± 63.4 min for total thyroidectomy, 111.0 ± 27.7 min for lobectomy, and 73.7 ± 18.1 min for isthmusectomy. Five patients (4.5%) experienced transient vocal cord palsy (VCP) and one (0.9%) had permanent VCP. The swallowing impairment index-6 score was 2.18 ± 3.21 at postoperative three months, and 0.97 ± 1.72 at postoperative six months. The learning curve for lobectomy was 58 cases in CUSUM analysis. TOETVA is a safe and feasible approach with an acceptable operation time and a low complication rate. This approach is a surgical option for patients who desire excellent cosmesis.
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Lim YS, Choi YJ, Kim BH, Kim HB, Cho CG, Park SW, Park JH. Changes in Tracheal Respiratory Mucosa After Thyroidectomy: A Rat Model. In Vivo 2021; 34:1133-1140. [PMID: 32354902 DOI: 10.21873/invivo.11885] [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: 02/03/2020] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM This study aimed to investigate changes in the tracheal mucosa after thyroidectomy, that can be a cause of post-thyroidectomy discomfort. MATERIALS AND METHODS Forty rats were divided into normal controls and 3 surgical groups: (i) thyroid isthmectomy with cauterization, (ii) isthmectomy by a cold instrument without hemostasis, and (iii) sham (exposure of the trachea and thyroid gland without thyroidectomy by dissection through pretracheal fascia). Animals were euthanized at 1 and 4 weeks. Mucosal edema and glandular hyperplasia were measured. Mucin production and basal cell activities were evaluated by mucin 5AC (MUC5AC) and keratin 5 (KRT5) using immunofluorescence staining. RESULTS Larger mucosal areas were observed in all surgical groups at 1 and 4 weeks. More submucosal glandular hyperplasia was noted in the group with isthmectomy without hemostasis. MUC5AC and KRT5 expressions were significantly higher in the surgical groups. CONCLUSION The tracheal mucosa may change after surgery, which could explain postoperative discomfort after thyroidectomy.
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Affiliation(s)
- Yun-Sung Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Yong Jun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Bo Hae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Hee-Bok Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Chang Gun Cho
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Seok-Won Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
| | - Joo Hyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Ilsan Hospital, Dongguk University, Goyang, Republic of Korea
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Huang TY, Yu WHV, Chiang FY, Wu CW, Fu SC, Tai AS, Lin YC, Tseng HY, Lee KW, Lin SH. Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery. Front Endocrinol (Lausanne) 2021; 12:788878. [PMID: 34867830 PMCID: PMC8635991 DOI: 10.3389/fendo.2021.788878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES High-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery. METHODS This study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient's answers on the IVST. RESULTS As the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV. CONCLUSION The factors that affect a patient's subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.
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Affiliation(s)
- Tzu-Yen Huang
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Wing-Hei Viola Yu
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, E-Da Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Che-Wei Wu
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chen Fu
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - An-Shun Tai
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
| | - Yi-Chu Lin
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsin-Yi Tseng
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ka-Wo Lee
- International Thyroid Surgery Center, Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Tatung Hospital, Kaohsiung Medical University Hospital, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Statistics, National Chiao Tung University, Hsinchu, Taiwan
- Institute of Data Science and Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Institute of Data Science and Engineering, National Chiao Tung University, Hsinchu, Taiwan
- *Correspondence: Sheng-Hsuan Lin,
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Zhou Q, Cai M, Gou J, Ning N. Effect of Postoperative High-Concentration Oxygen on Recovery After Thyroid Surgery: A Prospective, Open, Randomized, Controlled Study. Front Endocrinol (Lausanne) 2021; 12:595571. [PMID: 34290666 PMCID: PMC8287853 DOI: 10.3389/fendo.2021.595571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 06/21/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate the effectiveness of high-concentration oxygen on the improvement of throat symptoms and voice changes after thyroid surgery and its protection of the parathyroid function. METHODS A total of 600 patients undergoing thyroid surgery who met the inclusion criteria were randomly divided into the experimental group (n = 300) and the control group (n = 300) by using a random number generator. The patients in the experimental group underwent high-oxygen treatment [FiO280 (8 L/min)] for 6 continuous hours after returning to the ward after surgery. The patients in the control group underwent low-oxygen treatment [FiO230 (2 L/min)] for 6 continuous hours after returning to the ward after surgery. RESULTS The postoperative incision pain score of patients in the experimental group was significantly better than that in the control group at 6 h (1.07 ± 0.80 VS 1.23 ± 0.95, P=0.031) and 12 h (1.08 ± 0.64 VS 1.20 ± 0.73, P=0.041). The postoperative throat pain score of the patients in the experimental group was significantly better than that of the control group at 6 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.011) and 12 h (1.40 ± 0.85 VS 1.59 ± 0.97, P=0.019). The PONV score of the patients in the experimental group was significantly better than that of the control group at 12 h (0.09 ± 0.19 VS 0.14 ± 0.37, P=0.024). The Voice Handicap Index score of the patients in the experimental group was significantly better than that of the control group at 24 h (2.89 ± 5.92 VS 4.10 ± 6.31, P=0.017), 36 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.035), and 48 h (2.46 ± 5.06 VS 3.43 ± 5.97, P=0.032). CONCLUSION High-concentration oxygen can alleviate PONV and pain after thyroid surgery, with less severe voice changes potentially. However, its effects on swallowing function, and parathyroid function need to be further verified. CLINICAL TRIAL REGISTRATION NUMBER ChiCTR-IOR-17012765 (China Clinical Trial Registry clinical trial registration center [http://www.chictr.org.cn/index.aspx).
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Affiliation(s)
- Qian Zhou
- Department of Thyroid Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Ming Cai
- Department of Thyroid Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Juxiang Gou
- Department of Thyroid Surgery, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
- *Correspondence: Ning Ning, ; Juxiang Gou,
| | - Ning Ning
- West China School of Nursing, Sichuan University/Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Ning Ning, ; Juxiang Gou,
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Groher ME. Iatrogenic Disorders. Dysphagia 2021. [DOI: 10.1016/b978-0-323-63648-3.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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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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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Hirota K, Nishimoto K, Kumai Y, Miyamaru S, Miyamoto T, Saito H, Ise M, Murakami D, Orita Y. Swallowing dysfunction following surgery for well-differentiated thyroid cancer with extrathyroid invasion. Int J Clin Oncol 2020; 25:1921-1927. [PMID: 32683511 DOI: 10.1007/s10147-020-01748-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Differentiated thyroid carcinoma (DTC) can invade the surrounding aerodigestive tract. Radical surgery for locally advanced DTC will require resection of the trachea, recurrent laryngeal nerve (RLN), inferior pharyngeal constrictor muscles (IPCMs), or a part of the esophagus. The purpose of this study was to demonstrate the effect of resection of these surrounding tissues combined with total thyroidectomy and neck dissection on swallowing function following surgery. METHODS We performed total thyroidectomy combined with neck dissection and resection of the RLN in 24 patients with DTC with extrathyroidal invasion (19 unilateral, 1 bilateral), IPCMs (n = 5), or muscle layers of esophagus (n = 9). Nine patients received a tracheostomy placement due to a window resection of the trachea for tumor invasion (n = 6) and necessary upper airway management (n = 3). We used the duration of nasogastric tube feeding to evaluate swallowing function following surgery. RESULTS Patients who underwent tracheostomy or IPCM resection showed significantly longer periods of tube feeding (p = 0.0057 and 0.0017, respectively). In contrast, resection of the unilateral RLN or esophageal muscle layer showed no difference in tube feeding duration. Multiple regression analysis indicated that tracheostomy and IPCM resection were significant independent predictors of longer periods of tube feeding (p = 0.04583 and 0.00087, respectively). CONCLUSION These results indicate that tracheostomy placement and resection of the IPCMs, together with total thyroidectomy, extends the tube feeding duration in the postoperative period.
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Affiliation(s)
- Kaoruko Hirota
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Kohei Nishimoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Satoru Miyamaru
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Takumi Miyamoto
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Haruki Saito
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Momoko Ise
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Daizo Murakami
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan
| | - Yorihisa Orita
- Department of Otolaryngology-Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto, Japan.
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Dhillon VK, Randolph GW, Stack BC, Lindeman B, Bloom G, Sinclair CF, Woodson G, Brooks JA, Childs LF, Esfandiari NH, Evangelista L, Guardiani E, Quintanilla-Dieck L, Naunheim MR, Shindo M, Singer M, Tolley N, Angelos P, Kupfer R, Banuchi V, Liddy W, Tufano RP. Immediate and partial neural dysfunction after thyroid and parathyroid surgery: Need for recognition, laryngeal exam, and early treatment. Head Neck 2020; 42:3779-3794. [PMID: 32954575 DOI: 10.1002/hed.26472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Laryngeal dysfunction after thyroid and parathyroid surgery requires early recognition and a standardized approach for patients that present with voice, swallowing, and breathing issues. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to define the terms "immediate vocal fold paralysis" and "partial neural dysfunction" and to provide clinical consensus statements based on review of the literature, integrated with expert opinion of the group. METHODS A multidisciplinary expert panel constructed the manuscript and recommendations for laryngeal dysfunction after thyroid and parathyroid surgery. A meta-analysis was performed using the literature and published guidelines. Consensus was achieved using polling and a modified Delphi approach. RESULTS Twenty-two panelists achieved consensus on five statements regarding the role of early identification and standardization of evaluation for patients with "immediate vocal fold paralysis" and "partial neural dysfunction" after thyroid and parathyroid surgery. CONCLUSION After endorsement by the AHNS Endocrine Section and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Vaninder K Dhillon
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University National Capital Region, Bethesda, Maryland, USA
| | - Gregory W Randolph
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendan C Stack
- Department of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Brenessa Lindeman
- Department of General Surgery, Surgical Oncology, University of Alabama, Birmingham, Alabama, USA
| | - Gary Bloom
- ThyCa: Thyroid Cancer Survivors' Association, Inc., Olney, Maryland, USA
| | - Catherine F Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Mount Sinai West Hospital, New York, New York, USA
| | - Gayle Woodson
- Department of Otolaryngology-Head and Neck Surgery, Drexel University, Philadelphia, Pennsylvania, USA
| | - Jennifer A Brooks
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lesley F Childs
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Nazanene H Esfandiari
- Department of Internal Medicine, Metabolism, Endocrinology & Diabetes (MEND), University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Evangelista
- Department of Otolaryngology-Head and Neck Surgery, University of California, Davis Medical Center, California, USA
| | - Elizabeth Guardiani
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore, Maryland, USA
| | - Lourdes Quintanilla-Dieck
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Matthew R Naunheim
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Maisie Shindo
- Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Oregon, Portland, USA
| | - Michael Singer
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health System, Detroit, Michigan, USA
| | - Neil Tolley
- Department of Otolaryngology-Head and Neck Surgery, Imperial College NHS Trust, London, UK
| | - Peter Angelos
- Department of Surgery, University of Chicago School of Medicine, Chicago, Illinois, USA
| | - Robbi Kupfer
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Victoria Banuchi
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell School of Medicine, New York, New York, USA
| | - Whitney Liddy
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University, Chicago, Illinois, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Costa BOID, Rodrigues DDSB, Magalhães DDDD, Santos AS, Santos RV, Azevedo EHM, Almeida AA, Pernambuco L. Quantitative Ultrasound Assessment of Hyoid Bone Displacement During Swallowing Following Thyroidectomy. Dysphagia 2020; 36:659-669. [PMID: 32889628 DOI: 10.1007/s00455-020-10180-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate temporal ultrasound measurements of the hyoid bone displacement during swallowing following thyroidectomy in women and to relate these measures to age, clinical outcomes, and upper digestive airway symptoms. The sample was divided into an experimental group (EG) of 20 women who underwent thyroidectomy (mean age = 49.55 years ± 15.14) and a control group (CG) of 20 healthy women volunteers (mean age = 40.75 years ± 15.92). Both groups were submitted to ultrasound assessment to obtain four temporal measurements of hyoid bone displacement during swallowing: elevation, anteriorization, maximum displacement, and maintenance of maximum displacement. In both groups, swallowing of ten milliliters of liquid and the same volume of thickened liquid (honey) were analyzed. The images were recorded on video (30 frames/second) and analyzed according to a standardized protocol. Temporal measurements of hyoid bone elevation and maximum displacement during swallowing of thickened liquid were significantly shorter in EG (p = 0.034 and p = 0.020, respectively). There were no differences in the swallowing of liquid, and no other variable was related to the ultrasound temporal measurements investigated. This study concludes that women who undergo thyroidectomy have a shorter time of hyoid bone elevation and maximum displacement during swallowing of 10 mL of thickened liquid.
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Affiliation(s)
- Bianca Oliveira Ismael da Costa
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Darlyane de Souza Barros Rodrigues
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Desiré Dominique Diniz de Magalhães
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Ary Serrano Santos
- Lauro Wanderley University Hospital (HULW/UFPB/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Ricardo Vieira Santos
- Lauro Wanderley University Hospital (HULW/UFPB/EBSERH), Universidade Federal da Paraíba (UFPB), R. Tabelião Stanislau Eloy, 585, Castelo Branco, João Pessoa, PB, 58050-585, Brazil
| | - Elma Heitmann Mares Azevedo
- Department of Speech, Language and Hearing Sciences, Universidade Federal do Espírito Santo (UFES), Av. Marechal Campos, 1468, Maruípe, Vitória, ES, 29043-900, Brazil
| | - Anna Alice Almeida
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.,Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil
| | - Leandro Pernambuco
- Graduate Program in Speech, Language and Hearing Sciences (PPgFon/UFPB-UFRN-UNCISAL), Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil. .,Department of Speech, Language and Hearing Sciences, Universidade Federal da Paraíba (UFPB), Campus I s/n, Cidade Universitária, João Pessoa, PB, 58051-900, Brazil.
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Laryngopharyngeal reflux as a potential cause of persistent local neck symptoms after total thyroidectomy. Eur Arch Otorhinolaryngol 2020; 278:1577-1583. [PMID: 32737644 PMCID: PMC8057997 DOI: 10.1007/s00405-020-06223-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/16/2020] [Indexed: 12/03/2022]
Abstract
Purpose Local neck symptoms (LNS) may be related to goiter, but are also reported by patients suffering from laryngeal–pharyngeal reflux (LPR). The aim of this study was to investigate whether LPR could play a role in the persistence of some LNS after total thyroidectomy (TT). Methods A consecutive case series of 160 patients with multinodular goiter (MNG) candidate for TT were included in this study. Each patient was closely studied for both the thyroid pathology and reflux disease before and 6 months after surgery to assess the persistence of LNS after surgery. Results Only throat discomfort showed a significant improvement (p = 0.031) after surgery. On the other hand, swallowing and voice disorders persisted after surgery in 82.3% and 77.3% of patients, respectively (p = 0.250 and p = 0.062), such as the correlated reflux laryngopharyngitis (p = 0.5). Conclusions LPR can be considered a predisposing factor or an important concurrent causa to the persistence of LNS after TT, in particular for swallowing disorders and voice disorders. In patients with non-toxic MNG who complain of local neck symptoms, the investigation of a possible coexistence of a reflux disease is appropriate before surgery. Patients should be informed about the possibility that some symptoms can persist even after removal of the goiter.
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Martins NMDS, Novalo-Goto ES, Diz-Leme ICM, Goulart T, Ranzatti RP, Leite AKN, Dedivitis RA, Matos LL. Patient Perception of Swallowing after Thyroidectomy in the Absence of Laryngeal Nerve Injury. ORL J Otorhinolaryngol Relat Spec 2020; 82:274-284. [PMID: 32683362 DOI: 10.1159/000508683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/14/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Swallowing and voice alterations may manifest in patients with thyroid disease, especially after thyroidectomy. OBJECTIVE To identify the prevalence of patients with complaints of swallowing disorders after thyroidectomy and to evaluate patients' perceptions regarding swallowing before and after the procedure. METHODS A prospective longitudinal study was performed with 26 consecutive patients undergoing a private service thyroidectomy, in which the presence of swallowing dysfunction was evaluated using validated questionnaires that addressed the perception of swallowing by patients before (on the day of surgery) and after the surgery (on the first postoperative day). RESULTS Of the 26 patients, 18 (69.2%) were subjected to total thyroidectomy and 8 to partial thyroidectomy. Analysis of the domains of the Swallowing Handicap Index questionnaire showed higher scores when evaluated on the first postoperative day, demonstrating a significant worsening in swallowing after the procedure. The same result was demonstrated for the final score of swallowing perception, with 15.3 and 30.8% of patients reporting moderate alterations before and after the thyroidectomy, respectively, and 11.5% reporting the alterations as severe. Swallowing and vocal symptoms on the first postoperative day were more prevalent in the procedure than previously mentioned. Eight patients (30.8%) noted swallowing alterations before the procedure, compared with 80.8% (21 cases) after thyroidectomy. CONCLUSION There was a prevalence of 42.3% in swallowing complaints on the first postoperative day, regardless of the lesion in the laryngeal innervation, and this prevalence was significantly higher than that prior to the procedure.
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Affiliation(s)
| | | | | | | | | | - Ana Kober Nogueira Leite
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), School of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Leandro Luongo Matos
- Head and Neck Surgery Department, Instituto do Câncer do Estado de São Paulo (Icesp), School of Medicine, University of São Paulo, São Paulo, Brazil,
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40
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Abstract
Introduction The most obvious indication for thyroid surgery is malignancy, but other indications are also not rare. As with any other surgical procedure, those surgeries also carry risks which can be classified as minor or major. Discussion In this overview, we present minor (seroma, scarring) and major complications of thyroid surgery (recurrent nerve injury, hypoparathyroidism, and bleeding). We discuss the possibilities of prevention and treatment of each of those complications. Conclusion In recent years, thyroid surgery is becoming safer due to the development of new surgical, hemostatic, and other techniques such as intraoperative monitoring of the recurrent laryngeal nerve and parathyroid gland detection.
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Affiliation(s)
| | - Mario Bilić
- University Department of Otolaryngology and Head and Neck Surgery, Zagreb University Hospital Center
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Đanić Hadžibegović A, Hergešić F, Babić E, Slipac J, Prstačić R. Thyroidectomy-related Swallowing Difficulties: Review of the Literature. Acta Clin Croat 2020; 59:38-49. [PMID: 34219883 PMCID: PMC8212616 DOI: 10.20471/acc.2020.59.s1.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.
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Affiliation(s)
| | - Filip Hergešić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ema Babić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Juraj Slipac
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
| | - Ratko Prstačić
- 1Clinical Department for ENT and Head and Neck Surgery, Zagreb University Hospital Centre, 2Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Croatia, 3School of Medicine, Zagreb University, Croatia, 4Faculty of Education and Rehabilitation Sciences University of Zagreb, Croatia
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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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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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44
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Ko HY, Lu IC, Chang PY, Wang LF, Wu CW, Yu WHV, Hwang TZ, Wang CC, Huang TY, Chiang FY. U-shaped strap muscle flap for difficult thyroid surgery. Gland Surg 2020; 9:372-379. [PMID: 32420261 DOI: 10.21037/gs.2020.02.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Open thyroidectomy via conventional midline approach can be challenging in complex thyroid surgeries. This study proposes a U-shaped strap muscle flap (USMF) technique that provides adequately wide exposure of the surgical field. Methods Strap muscles were cut close to the clavicle and along the anterior margin of both sternocleidomastoid muscles followed by total thyroidectomy in 20 patients as USMF group, and surgical outcomes were compared with 40 patients who had received total thyroidectomy via midline approach. Results No patient had postoperative hematoma, vocal cord paralysis, permanent hypocalcaemia, wound infection or flap necrosis. At 2 months post-surgery, objective voice analysis and subjective assessment of voice and swallowing showed no significant difference between groups. Conclusions USMF provides superb surgical field exposure, and the voice and swallowing functions after USMF are comparable to those obtained by midline approach. The USMF approach is a feasible option for selective difficult thyroid surgery.
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Affiliation(s)
- How-Yun Ko
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Feng Wang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wing-Hei Viola Yu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tzer Zen Hwang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
| | | | - Tzu-Yen Huang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Feng-Yu Chiang
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Otolaryngology, E-Da Hospital, Kaohsiung, Taiwan
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45
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Gong Y, Xu X, Wang J, Che L, Wang W, Yi J. Laryngeal mask airway reduces incidence of post-operative sore throat after thyroid surgery compared with endotracheal tube: a single-blinded randomized controlled trial. BMC Anesthesiol 2020; 20:16. [PMID: 31937238 PMCID: PMC6961403 DOI: 10.1186/s12871-020-0932-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sore throat is a remarkable complication after thyroid surgery with endotracheal tube (ETT). Many studies revealed that laryngeal mask airway (LMA) might reduce the incidence and severity of postoperative sore throat. However, little is known about the use of a flexible reinforced LMA (FLMA) in thyroid surgery. The purpose of this study was to explore the potential benefits of FLMA compared with ETT on postoperative sore throat. METHODS In this prospective, single-blinded, randomized, controlled trial, ninety-six patients aged 20-80 years, scheduled for elective radical thyroidectomy under general anesthesia were enrolled. They were randomly divided into ETT group and FLMA group. All the included patients received total intravenous anesthesia (with propofol, fentanyl and rocuronium) and controlled mechanical ventilation during the surgery. Cuff pressure of ETT and FLMA were strictly controlled. Incidence and severity of postoperative sore throat, numbness and hoarseness at 1, 24, and 48 h after surgery was evaluated and compared between the two groups. Incidence and severity of buckling during extubation and the hemodynamic profile during intubation were also recorded and compared. RESULTS The incidence of sore throat and hoarseness was significantly lower in FLMA group than those in ETT group at 1 h, 24 h and 48 h postoperatively, as well as the severity of sore throat. Compared to ETT group, there was a significantly lower incidence of buckling during extubation and less fluctuation of HR and BP at 1 min and 3 min after intubation in FLMA group. CONCLUSIONS Patients undergoing thyroid surgery with FLMA had less postoperative laryngopharyngeal symptoms when compared with ETT. The use of FLMA also achieved less buckling during extubation and better hemodynamic profiles during intubation. TRIAL REGISTRATION The research was registered in Chinese Clinical Trial Registry (ChiCTR-IOR-15006602) on May 23th, 2015.
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Affiliation(s)
- Yahong Gong
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Xiaohan Xu
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jin Wang
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Lu Che
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Weijia Wang
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China
| | - Jie Yi
- Department of Anesthesiology, Peking Union Medical College Hospital (PUMCH), 1 Shuai Fuyuan, Wangfujing Street, Dongcheng District, Beijing, 100730, China.
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46
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Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study. Surgery 2020; 167:129-136. [DOI: 10.1016/j.surg.2019.05.090] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/03/2019] [Accepted: 05/06/2019] [Indexed: 11/24/2022]
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47
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Objective analysis of swallowing and functional voice outcomes after thyroidectomy: A prospective cohort study. Asian J Surg 2020; 43:116-123. [DOI: 10.1016/j.asjsur.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/07/2018] [Accepted: 04/15/2019] [Indexed: 01/24/2023] Open
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48
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Minni A, Rosati D, Cavaliere C, Ralli M, Sementilli G, Gallo A, Brozzetti S, Ossola P, Cavallaro G, Bononi M. Total Versus Completion Thyroidectomy: A Multidimensional Evaluation of Long-Term Vocal Alterations. EAR, NOSE & THROAT JOURNAL 2019; 100:562S-568S. [PMID: 31801365 DOI: 10.1177/0145561319886156] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Total thyroidectomy (TT) and completion thyroidectomy (CT) are two common surgical operations that are frequently followed by vocal symptoms despite preservation of the recurrent laryngeal nerve (RLN) and of the external branch of superior laryngeal nerve (EBSLN). The aim of this study was to analyze vocal alterations through endoscopic findings, videolaryngostroboscopy (VLS), acoustic vocal parameters and impact on patients' quality of life after surgery in the absence of laryngeal nerve injury. METHODS We enrolled 198 patients who underwent thyroidectomy by the same surgeon. One hundred twenty-six patients underwent TT (group TT) while 72 underwent CT (group CT). All patients underwent preoperative VLS and Voice Handicap Index (VHI) assessment and postoperative VHI, VLS and Acoustic Voice Analysis with Multidimensional Voice Program Analysis 12 to 18 months after surgery. RESULTS We observed a statistically significant higher rate of EBSLN injury in CT compared to TT. Even in the absence of RLN and EBSLN injury, patients who underwent TT and CT presented slightly worse acoustic vocal parameters and VHI scores compared to healthy controls. Interestingly, some acoustic vocal parameters and VHI scores were significantly worse in group CT compared to group TT. CONCLUSIONS The higher rate of EBSLN injury in CT rather than in TT suggests a higher surgical risk in CT. The vocal parameters of loudness and self-perception of voice were significantly worse after CT, suggesting a larger trauma in patients' vocal outcome in CT if compared to TT, although these alterations were not reported as psychologically limiting daily life of patients. Nevertheless, the existence of multiple factors contributing to vocal alterations after thyroidectomy highlight the importance of a routine comprehensive functional voice analysis before and after surgery.
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Affiliation(s)
- Antonio Minni
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Davide Rosati
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Carlo Cavaliere
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Giulio Sementilli
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Andrea Gallo
- Department of Sense Organs, 9311Sapienza University of Rome, Rome, Italy
| | - Stefania Brozzetti
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Paolo Ossola
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Giuseppe Cavallaro
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
| | - Marco Bononi
- Department of Surgery "P. Valdoni", 9311Sapienza University of Rome, Rome, Italy
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49
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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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Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, Connor NP. Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study. JAMA Otolaryngol Head Neck Surg 2019. [PMID: 29522149 DOI: 10.1001/jamaoto.2017.3378] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance It is important that clinicians understand consequences of thyoridectomy on swallowing from the patient perspective to better care for this population. Objective Using rigorous qualitative methodology, this study set out to characterize the effect of swallowing-related symptoms after thyroidectomy on patient quality of life and swallowing-related outcomes. Design, Setting, and Participants Prospective, grounded theory analysis of interviews with 26 patients at 3 time points after thyroidectomy (2 weeks, 6 weeks, and 6 months). Data were collected from an ongoing clinical trial (NCT02138214), and outpatient interviews were conducted at the University of Wisconsin Hospital and Clinics. All participants were age 21 to 73 years with a diagnosis of papillary thyroid cancer without cervical or distant metastases and had undergone total thyroidectomy. Exclusion criteria were preexisting vocal fold abnormalities (eg, polyps, nodules), neurological conditions affecting the voice or swallowing ability, and/or development of new-onset vocal fold paresis or paralysis (lasting longer than 6 months) after total thyroidectomy. Interventions Total thyroidectomy. Main Outcomes and Measures Symptoms of dysphagia and related effects on quality of life elicited through grounded theory analysis of semistructured interviews with patients after thyroidectomy designed to foster an open-ended, patient-driven discussion. Results Of the 26 patients included, 69% were women (n = 18); mean (SD) age, 46.4 (14.1) years; mean (SD) tumor diameter 2.2 (1.4) cm. Two weeks after thyroidectomy, 80% of participants (n = 20) reported at least 1 swallowing-related symptom when prompted by the interview cards; during the open interview, 53% of participants (n = 14) volunteered discussion of swallowing-related symptoms unprompted. However, only 8% of participants in this study (n = 2) qualified for a follow-up dysphagia evaluation, indicating that the majority of reported symptoms were subjective in nature. Six weeks and 6 months after thyroidectomy, 42% (n = 11) and 17% (n = 4) of participants, respectively, reported continued swallowing symptoms using the prompts; 12% (n = 3) discussed symptoms without prompting cards at both time points. Conclusions and Relevance Swallowing symptoms after thyroidectomy are underreported in the literature. This study revealed that as many as 80% of patients who have thyroidectomy may experience swallowing-related symptoms after surgery, and many develop compensatory strategies to manage or reduce the burden of these symptoms. Considering the large number of individuals who may experience subjective dysphagia, preoperative counseling should include education and management of such symptoms.
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Affiliation(s)
- Brittany N Krekeler
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison
| | - Elizabeth Wendt
- University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Jason Orne
- Department of Sociology, Drexel University, Philadelphia, Pennsylvania
| | - David O Francis
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison.,Wisconsin Surgical Outcomes Research Program, Madison.,Department of Surgery, Division of General Surgery, University of Wisconsin, Madison
| | | | - Nadine P Connor
- Department of Communication Sciences and Disorders, University of Wisconsin, Madison.,Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin, Madison
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