World Journal of Surgery

, Volume 38, Issue 3, pp 607–613 | Cite as

Is Vocal Cord Asymmetry Seen on Transcutaneous Laryngeal Ultrasonography a Significant Predictor of Voice Quality Changes After Thyroidectomy?

  • Kai-Pun Wong
  • Brian Hung-Hin LangEmail author
  • Sze-How Ng
  • Chung-Yeung Cheung
  • Christina Tin-Yan Chan
  • Miu-Yee Chan



Vocal cord asymmetry (VCA) on laryngoscopic examination (LE) may suggest voice impairment after thyroidectomy, but LE may cause patient discomfort. We aimed to correlate the presence of postoperative VCA assessed by noninvasive transcutaneous laryngeal ultrasonography (TLUSG) with voice quality changes after thyroidectomy.


A total of 169 patients scheduled for thyroidectomy completed two validated voice symptoms questionnaires—the GRBAS (grade, roughness, breathiness, asthenia, strain) scale and the voice impairment score (VIS)—and underwent TLUSG and LE at 1 day before and 7–10 days after thyroidectomy. Postoperative VCA was apparent in 51 patients on TLUSG (group I), whereas there was no VCA in the other 118 patients (group II, controls). The GRBAS scale and VIS results were compared between the groups.


Before operation, the two groups had comparable preoperative GRBAS and VIS status. After operation, the “grade” and “roughness” components on the GRBAS scale were significantly worse in group I than in group II: 0.24 versus 0.07 (p = 0.016) and 0.33 versus 0.14 (p = 0.022), respectively. “Grade” and “roughness” in the GRBAS scale significantly worsened after the operation in group I: from 0.04 to 0.24 (p = 0.008) and from 0.02 to 0.33 (p = 0.001), respectively. They did not change in group II. Also, the overall VIS was significantly worse after thyroidectomy in group I: 4.97 versus 12.97 (p < 0.001).


VCA seen on TLUSG significantly correlated with “grade” and “roughness” components on the GRBAS scale and the overall VIS. Thus, VCA might be used as a surrogate of postoperative voice changes.


Vocal Cord Direct Laryngoscopy Voice Change Laryngoscopic Examination Cricothyroid Muscle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Kai-Pun Wong
    • 1
  • Brian Hung-Hin Lang
    • 1
    Email author
  • Sze-How Ng
    • 2
  • Chung-Yeung Cheung
    • 1
  • Christina Tin-Yan Chan
    • 1
  • Miu-Yee Chan
    • 1
  1. 1.Division of Endocrine Surgery, Department of Surgery, Queen Mary HospitalThe University of Hong KongHong Kong SARChina
  2. 2.Breast & Endocrine Unit, Department of SurgeryKuala Lumpur HospitalKuala LumpurMalaysia

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