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Pre- and Post-Thyroidectomy Voice Assessment

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Controversies in Thyroid Surgery

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Abstract

After thyroid surgery, a change in voice from baseline is considered to be the most common complication. The presence or absence of recurrent laryngeal nerve (RLN) dysfunction does not solely predict functional voice outcome after thyroidectomy, as other mechanisms can affect vocal fold function. Nonetheless, when reading the pertinent literature, it becomes obvious that the true incidence of temporary and permanent vocal fold paralysis (VFP) after thyroid surgery is still unknown. The majority of previous studies that have examined the incidence of VFP have lacked adequate assessment of postoperative vocal fold function. The reason for this variance in practice is due to the lack of consensus from the surgical professional societies and the difference in the professional background and training of today’s thyroid surgeons. Such statistics about the true risk of RLN injury with subsequent temporary or permanent VFP rates are important in obtaining informed patient consent before proceeding with thyroidectomy. Pre- and postoperative assessment of vocal fold function for patients undergoing thyroid surgery may help to detect an existing preoperative RLN palsy or an early iatrogenic RLN injury. Knowing this information may help to develop an appropriate surgical plan preoperatively and intervene supportively in a patient who may have vocal fold motion impairment postoperatively. Herein, we discuss the technical considerations for voice assessment during thyroid surgery and the rationale for routine pre- and postoperative laryngeal assessment of the larynx.

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References

  1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19(11):1167–214.

    Article  PubMed  Google Scholar 

  2. Kandil E, Noureldine SI, Abbas A, Tufano RP. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery. 2013;154(6):1346–52. Discussion 52–3.

    Article  PubMed  Google Scholar 

  3. de Pedro NI, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, et al. Voice and vocal self-assessment after thyroidectomy. Head Neck. 2006;28(12):1106–14.

    Article  Google Scholar 

  4. Musholt TJ, Musholt PB, Garm J, Napiontek U, Keilmann A. Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery. 2006;140(6):978–88. Discussion 88–9.

    Article  PubMed  Google Scholar 

  5. Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg. 2002;236(6):823–32.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Rosato L, Carlevato MT, De Toma G, Avenia N. Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World J Surg. 2005;29(6):780–4.

    Article  PubMed  Google Scholar 

  7. Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract. 2009;63(4):624–9.

    Article  PubMed  Google Scholar 

  8. Hartl DM, Travagli JP, Leboulleux S, Baudin E, Brasnu DF, Schlumberger M. Clinical review: Current concepts in the management of unilateral recurrent laryngeal nerve paralysis after thyroid surgery. J Clin Endocrinol Metab. 2005;90(5):3084–8.

    Article  CAS  PubMed  Google Scholar 

  9. McIvor NP, Flint DJ, Gillibrand J, Morton RP. Thyroid surgery and voice-related outcomes. Aust N Z J Surg. 2000;70(3):179–83.

    Article  CAS  PubMed  Google Scholar 

  10. Roubeau B, Chevrie-Muller C, Lacau Saint Guily J. Electromyographic activity of strap and cricothyroid muscles in pitch change. Acta Otolaryngol. 1997;117(3):459–64.

    Article  CAS  PubMed  Google Scholar 

  11. Jones MW, Catling S, Evans E, Green DH, Green JR. Hoarseness after tracheal intubation. Anaesthesia. 1992;47(3):213–6.

    Article  CAS  PubMed  Google Scholar 

  12. Farrag TY, Samlan RA, Lin FR, Tufano RP. The utility of evaluating true vocal fold motion before thyroid surgery. Laryngoscope. 2006;116:235–8. United States.

    Article  PubMed  Google Scholar 

  13. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg. 1997;117(4):399–404.

    Article  CAS  PubMed  Google Scholar 

  14. Debruyne F, Ostyn F, Delaere P, Wellens W. Acoustic analysis of the speaking voice after thyroidectomy. J Voice. 1997;11(4):479–82.

    Article  CAS  PubMed  Google Scholar 

  15. Debruyne F, Ostyn F, Delaere P, Wellens W, Decoster W. Temporary voice changes after uncomplicated thyroidectomy. Acta Otorhinolaryngol Belg. 1997;51(3):137–40.

    CAS  PubMed  Google Scholar 

  16. Dionigi G, Boni L, Rovera F, Rausei S, Castelnuovo P, Dionigi R. Postoperative laryngoscopy in thyroid surgery: proper timing to detect recurrent laryngeal nerve injury. Langenbecks Arch Surg. 2010;395(4):327–31.

    Article  PubMed  Google Scholar 

  17. Bergenfelz A, Jansson S, Kristoffersson A, Martensson H, Reihner E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg. 2008;393(5):667–73.

    Article  CAS  PubMed  Google Scholar 

  18. Abadin SS, Kaplan EL, Angelos P. Malpractice litigation after thyroid surgery: the role of recurrent laryngeal nerve injuries, 1989-2009. Surgery. 2010;148(4):718–22. Discussion 22–3.

    Article  PubMed  Google Scholar 

  19. Randolph GW. The importance of pre- and postoperative laryngeal examination for thyroid surgery. Thyroid. 2010;20(5):453–8.

    Article  PubMed  Google Scholar 

  20. Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery. 2006;139:357–62. United States.

    Article  PubMed  Google Scholar 

  21. Steurer M, Passler C, Denk DM, Schneider B, Niederle B, Bigenzahn W. Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope. 2002;112(1):124–33.

    Article  PubMed  Google Scholar 

  22. Lombardi CP, Raffaelli M, D’Alatri L, Marchese MR, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006;140(6):1026–32. Discussion 32–4.

    Article  PubMed  Google Scholar 

  23. Peppard SB, Dickens JH. Laryngeal injury following short-term intubation. Ann Otol Rhinol Laryngol. 1983;92(4 Pt 1):327–30.

    Article  CAS  PubMed  Google Scholar 

  24. Echternach M, Maurer CA, Mencke T, Schilling M, Verse T, Richter B. Laryngeal complications after thyroidectomy: is it always the surgeon? Arch Surg. 2009;144(2):149–53. Discussion 53.

    Article  PubMed  Google Scholar 

  25. Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay MJ, Coppit GL, et al. Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia. Surgery. 2008;143(6):732–42.

    Article  PubMed  Google Scholar 

  26. Sittel C, Stennert E, Thumfart WF, Dapunt U, Eckel HE. Prognostic value of laryngeal electromyography in vocal fold paralysis. Arch Otolaryngol Head Neck Surg. 2001;127(2):155–60.

    Article  CAS  PubMed  Google Scholar 

  27. Shin JJ, Grillo HC, Mathisen D, Katlic MR, Zurakowski D, Kamani D, et al. The surgical management of goiter: Part I. Preoperative evaluation. Laryngoscope. 2011;121(1):60–7.

    Article  PubMed  Google Scholar 

  28. Fenton JE, Timon CI, McShane DP. Recurrent laryngeal nerve palsy secondary to benign thyroid disease. J Laryngol Otol. 1994;108(10):878–80.

    Article  CAS  PubMed  Google Scholar 

  29. Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, et al. Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg. 2013;148 Suppl 6:S1–37.

    Article  PubMed  Google Scholar 

  30. Bora MK, Narwani S, Agarwal S, Bapna AS. A study of routine exposure of recurrent laryngeal nerve during thyroid surgery. Indian J Otolaryngol Head Neck Surg. 2005;57(3):182–4.

    PubMed Central  CAS  PubMed  Google Scholar 

  31. Laeeq K, Pandian V, Skinner M, Masood H, Stewart CM, Weatherly R, et al. Learning curve for competency in flexible laryngoscopy. Laryngoscope. 2010;120(10):1950–3.

    Article  PubMed  Google Scholar 

  32. Wong KP, Lang BH, Ng SH, Cheung CY, Chan CT, Lo CY. A prospective, assessor-blind evaluation of surgeon-performed transcutaneous laryngeal ultrasonography in vocal cord examination before and after thyroidectomy. Surgery. 2013;154(6):1158–64. Discussion 64–5.

    Article  PubMed  Google Scholar 

  33. Cheng SP, Lee JJ, Liu TP, Lee KS, Liu CL. Preoperative ultrasonography assessment of vocal cord movement during thyroid and parathyroid surgery. World J Surg. 2012;36(10):2509–15.

    Article  PubMed  Google Scholar 

  34. Wang CP, Chen TC, Yang TL, Chen CN, Lin CF, Lou PJ, et al. Transcutaneous ultrasound for evaluation of vocal fold movement in patients with thyroid disease. Eur J Radiol. 2012;81(3):e288–91.

    Article  PubMed  Google Scholar 

  35. Dedecjus M, Adamczewski Z, Brzezinski J, Lewinski A. Real-time, high-resolution ultrasonography of the vocal folds–a prospective pilot study in patients before and after thyroidectomy. Langenbecks Arch Surg. 2010;395(7):859–64.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Carneiro-Pla D, Miller BS, Wilhelm SM, Milas M, Gauger PG, Cohen MS, et al. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156:1597–602.

    Article  PubMed  Google Scholar 

  37. Friedman EM. Role of ultrasound in the assessment of vocal cord function in infants and children. Ann Otol Rhinol Laryngol. 1997;106(3):199–209.

    Article  CAS  PubMed  Google Scholar 

  38. Wong KP, Lang BH, Chang YK, Wong KC, Chow FC. Assessing the validity of Transcutaneous Laryngeal Ultrasonography (TLUSG) after thyroidectomy: what factors matter? Ann Surg Oncol. 2014;22:1774–80.

    Article  PubMed  Google Scholar 

  39. Sidhu S, Stanton R, Shahidi S, Chu J, Chew S, Campbell P. Initial experience of vocal cord evaluation using grey-scale, real-time, B-mode ultrasound. ANZ J Surg. 2001;71:737–9. Australia.

    Article  CAS  PubMed  Google Scholar 

  40. Vats A, Worley GA, de Bruyn R, Porter H, Albert DM, Bailey CM. Laryngeal ultrasound to assess vocal fold paralysis in children. J Laryngol Otol. 2004;118(6):429–31.

    Article  CAS  PubMed  Google Scholar 

  41. Bozzato A, Zenk J, Gottwald F, Koch M, Iro H. Influence of thyroid cartilage ossification in laryngeal ultrasound. Laryngorhinootologie. 2007;86(4):276–81.

    Article  CAS  PubMed  Google Scholar 

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Conflicts of Interest Disclosures

All authors report no conflicts of interest.

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Authors and Affiliations

  1. Division of Head and Neck Endocrine Surgery, Department of Otolaryngology—Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th floor (6242), Baltimore, MD, 21287, USA

    Salem I. Noureldine M.D. & Ralph P. Tufano M.D., M.B.A., F.A.C.S.

Authors
  1. Salem I. Noureldine M.D.
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  2. Ralph P. Tufano M.D., M.B.A., F.A.C.S.
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Correspondence to Ralph P. Tufano M.D., M.B.A., F.A.C.S. .

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Editors and Affiliations

  1. Department of Surgery; University of Virginia Health System, C Bruce Morton Professor and Chief; Division of General Surgery, Charlottesville, Virginia, USA

    John B. Hanks

  2. Chairman Department of Surgery, Mount Sinai Beth Israel, Eugene W Friedman Professor of Surgery; Icahn School of Medicine at Mount Sinai, New York, New York, USA

    William B. Inabnet III

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Noureldine, S.I., Tufano, R.P. (2016). Pre- and Post-Thyroidectomy Voice Assessment. In: Hanks, J., Inabnet III, W. (eds) Controversies in Thyroid Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-20523-6_3

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  • DOI: https://doi.org/10.1007/978-3-319-20523-6_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-20522-9

  • Online ISBN: 978-3-319-20523-6

  • eBook Packages: MedicineMedicine (R0)

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