Abstract
Vocal cord palsy (VCP) is a major complication of thyroidectomy. Some patients have preexisting VCP prompting the need for routine or selective preoperative evaluation of the vocal cords. The study aims at ascertaining the prevalence of preoperative VCP and making appropriate recommendations. This is a retrospective study of all adult patients who had thyroidectomy at the University of Nigeria Teaching Hospital. Case notes of patients who had thyroidectomy at the hospital from July 2010 to June 2015 were retrieved. Variables studied included biodata, duration of goiter, preoperative hoarseness, outcome of indirect laryngoscopy (IDL), histology of specimen, duration of follow-up, and incidence of postoperative hoarseness. Descriptive statistical analysis was done using SPSS version 20. Of the 91 patients aged 21–70 years (mean 42.08 years, SD 15.40), females outnumbered males with a M:F ratio of 1:10.4. Five patients had preoperative hoarseness, but only three had VCP. IDL was done for 25 (27.4%) patients out of which 22 (88.0%) had normal studies while the remaining three (all from the five with hoarseness) had VCP. Histology of the specimens showed malignancy in 10 (11%), benign in 55 (60.4%), and no report in 26 (28.6%). Five of the malignant histology patients showed normal findings on IDL, three had VCP and two had no preoperative IDL. There was no case of asymptomatic VCP. Vocal cord evaluation is recommended for patients with voice symptoms and those with malignant goiter.
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Zakaria HM, Awad NA, Kreedes AS et al (2011) Recurrent laryngeal nerve injury in thyroid surgery. Oman Medical Journal 26(1):34–38
Chiang FY, Wang LF, Huang YF et al (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137(3):342–347
Jeannon JP, Orabi AA, Burch GA et al (2009) Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 63:624–629
Bergenfelz A, Jansson S, Kristoffersson A et al (2008) Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbeck's Arch Surg 393:667–673
Scott-Combes D, Kinsman R, Walton P (2009) The British Association of Endocrine and Thyroid Surgeons; Third National Audit Report
Sancho JJ, Pascual-Damieta M, Pereira JA et al (2008) Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg 95:961–967
Guzmán F, Carmen G, Yari YA et al (2015) Is there a case for selective, rather than routine, preoperative laryngoscopy in thyroid surgery? Gland Surgery 4(1):8–18
Yeung P, Erskine C, Mathews P et al (1999) Voice changes and thyroid surgery: is pre-operative indirect laryngoscopy necessary? Aust N Z J Surg 69:632–634
Schlosser K, Zeuner M, Wagner M et al (2007) Laryngoscopy in thyroid surgery—essential standard or unnecessary routine? Surgery 142:858–864 discussion 864
Lang BH, Chu KK, Tsang RK et al (2014) Evaluating the incidence, clinical significance and predictors for vocal cord palsy and incidental laryngopharyngeal conditions before elective thyroidectomy: is there a case for routine laryngoscopic examination? World J Surg 38:385–391
Lee CY, Long KL, Eldridge RJ et al (2014) Preoperative laryngoscopy in thyroid surgery: do patients’ subjective voice complaints matter? Surgery 156:1477–1482
Shin JJ, Grillo HC, Mathisen D et al (2011) The surgical management of goiter: part I. Preoperative evaluation. Laryngoscope 121:60–67
Steurer M, Passler C, Denk DM et al (2002) 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 112:124–133
Randolph GW (2010) The importance of pre- and postoperative laryngeal examination for thyroid surgery. Thyroid 20:453–458
Kuppersmith RB (2013) Surgeon-performed laryngeal ultrasound can be used to screen for vocal cord abnormalities before thyroid surgery. Clinical Thyroidology 25:113–115
Myssiorek D (2004) Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin N Am 37:25–44
Hodin R, Clark O, Doherty G et al (2013) Voice issues and laryngoscopy in thyroid surgery patients. Surgery 154:46–47
World Bank (2003) World development indicators World Bank. Washington DC
Farrag TY, Samlan RA, Lin FR et al (2006) The utility of evaluating true vocal fold motion before thyroid surgery. Laryngoscope 116:235–238
Järhult J, Lindestad PA, Nordenström J et al (1991) Routine examination of the vocal cords before and after thyroid and parathyroid surgery. Br J Surg 78:1116–1117
Gharib H, Papini E, Paschke R et al (2010) American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract 16(Suppl 1):1–43
Cooper DS, Doherty GM, Haugen BR et al (2009) American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Gómez Sáez JM (2010) Taking of position in relationship to the protocol of the current treatment of thyroid nodules and differentiated thyroid cancer. Endocrinol Nutr 57:370–375
Garrett CG, Cohen SM (2008) Otorhinolaryngological perspective on patients with throat symptoms and laryngeal irritation. Curr Gastroentrol Rep 10(3):195–199
Roth DF, Ferguson BJ (2010) Vocal allergy: recent advances in understanding the role of allergy in dysphonia. Curr Opin Otolaryngol Head Neck Surg 18(3):176–181
Farrokhi F, Vaezi MF (2007) Laryngeal disorders in patients with gastroesophageal reflux disease. Minerva Gastroenterol Dietol 53(2):181–187
Sittel C, Stennert E, Thumfart WF et al (2001) Prognostic value of laryngeal electromyography in vocal fold paralysis. Arch Otolaryngol Head Neck Surg 127:155–160
Debruyne F, Ostyn F, Delaere P et al (1997) Temporary voice changes after uncomplicated thyroidectomy. Acta Otorhinolaryngol Belg 51:137–140
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Agu, K.A., Nwosu, J.N. & Akpeh, J.O. Evaluation of Vocal Cord Function Before Thyroidectomy: Experience from a Developing Country. Indian J Surg 80, 211–215 (2018). https://doi.org/10.1007/s12262-016-1577-8
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DOI: https://doi.org/10.1007/s12262-016-1577-8