Skip to main content
Log in

Evaluation of Vocal Cord Function Before Thyroidectomy: Experience from a Developing Country

  • Original Article
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Zakaria HM, Awad NA, Kreedes AS et al (2011) Recurrent laryngeal nerve injury in thyroid surgery. Oman Medical Journal 26(1):34–38

    Article  PubMed  PubMed Central  Google Scholar 

  2. 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

    Article  PubMed  Google Scholar 

  3. 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

    Article  PubMed  Google Scholar 

  4. 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

    Article  CAS  Google Scholar 

  5. Scott-Combes D, Kinsman R, Walton P (2009) The British Association of Endocrine and Thyroid Surgeons; Third National Audit Report

  6. 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

    Article  PubMed  CAS  Google Scholar 

  7. 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

    Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Schlosser K, Zeuner M, Wagner M et al (2007) Laryngoscopy in thyroid surgery—essential standard or unnecessary routine? Surgery 142:858–864 discussion 864

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Lee CY, Long KL, Eldridge RJ et al (2014) Preoperative laryngoscopy in thyroid surgery: do patients’ subjective voice complaints matter? Surgery 156:1477–1482

    Article  PubMed  Google Scholar 

  12. Shin JJ, Grillo HC, Mathisen D et al (2011) The surgical management of goiter: part I. Preoperative evaluation. Laryngoscope 121:60–67

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. Randolph GW (2010) The importance of pre- and postoperative laryngeal examination for thyroid surgery. Thyroid 20:453–458

    Article  PubMed  Google Scholar 

  15. Kuppersmith RB (2013) Surgeon-performed laryngeal ultrasound can be used to screen for vocal cord abnormalities before thyroid surgery. Clinical Thyroidology 25:113–115

    Google Scholar 

  16. Myssiorek D (2004) Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin N Am 37:25–44

    Article  Google Scholar 

  17. Hodin R, Clark O, Doherty G et al (2013) Voice issues and laryngoscopy in thyroid surgery patients. Surgery 154:46–47

    Article  PubMed  Google Scholar 

  18. World Bank (2003) World development indicators World Bank. Washington DC

  19. Farrag TY, Samlan RA, Lin FR et al (2006) The utility of evaluating true vocal fold motion before thyroid surgery. Laryngoscope 116:235–238

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. 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

    Article  PubMed  Google Scholar 

  23. 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

    Article  PubMed  Google Scholar 

  24. Garrett CG, Cohen SM (2008) Otorhinolaryngological perspective on patients with throat symptoms and laryngeal irritation. Curr Gastroentrol Rep 10(3):195–199

    Article  Google Scholar 

  25. 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

    Article  PubMed  Google Scholar 

  26. Farrokhi F, Vaezi MF (2007) Laryngeal disorders in patients with gastroesophageal reflux disease. Minerva Gastroenterol Dietol 53(2):181–187

    PubMed  CAS  Google Scholar 

  27. 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

    Article  PubMed  CAS  Google Scholar 

  28. Debruyne F, Ostyn F, Delaere P et al (1997) Temporary voice changes after uncomplicated thyroidectomy. Acta Otorhinolaryngol Belg 51:137–140

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kenneth A. Agu.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-016-1577-8

Keywords

Navigation