Advertisement

Impact of Uncomplicated Total Thyroidectomy on Voice and Swallowing Symptoms: a Prospective Clinical Trial

  • Jiannis K. HajiioannouEmail author
  • Eleni Sioka
  • Stergiani Tsiouvaka
  • Christos Korais
  • Dimitrios Zacharoulis
  • John Bizakis
Original Article
  • 6 Downloads

Abstract

Voice and swallowing alterations are frequently reported after thyroidectomy, even in absence of nerve injury. The symptoms impair the quality of life. Aim of the study was to evaluate prospectively vocal function and swallowing symptom changes after total thyroidectomy in the early and late postoperative period. Prospective observational study. All consecutive patients scheduled for total thyroidectomy were included. Subjective voice evaluation using the Greek version of Voice Handicap Index (VHI) was performed preoperatively and at 2nd postoperative day, 1 month, 12 months postoperatively to assess the functional outcome. Laryngoscopy was performed at the same timing. Subjective swallowing evaluation using the Swallowing Impairment score (SIS) evaluated the swallowing symptoms. The study population included 125 patients. Total VHI score differed significantly between preoperative values and at 48 h and 1 year postoperatively (p = 0.000). Significant changes were observed for the functional and emotional domain of VHI between preoperative and 48 h postoperatively (p = 0.001, 0.003, respectively). There were statistically significant changes for physical domain of VHI between preoperative values and values at 48 h and 1 year (p = 0.000, 0.001, respectively). Regarding the swallowing symptoms, the mean postoperative score at 1 month did not differ significantly from the mean preoperative score (p = 0.103). Swallowing alterations showed a tendency to increase 48 h postoperatively and decreased thereafter. Swallowing score at 1 year postoperatively was statistical significant lower compared to preoperative values. Even with intact laryngeal nerves, transient voice and swallowing alterations may occur after total thyroidectomy. Patients should be informed about these mild changes to lower anxiety following the operation.

Keywords

Total thyroidectomy Voice handicap index Swallowing disorders Thyroid surgery Voice disorders 

Notes

Compliance with Ethical Standards

The study was conducted after approval of the Institutional Ethics Committee. All clinical investigations were conducted in accordance with the guidelines in the Declaration of Helsinki.

Conflict of Interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, Benninger MS, Blumin JH, Dennis G, Hanks J, Haymart MR, Kloos RT, Seals B, Schreibstein JM, Thomas MA, Waddington C, Warren B, Robertson PJ, American Academy of Otolaryngology-Head and Neck Surgery (2013) Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg 148:S1–S37CrossRefGoogle Scholar
  2. 2.
    Hong KH, Kim YK (1997) Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 117:399–404CrossRefGoogle Scholar
  3. 3.
    de Pedro NI, Fae A, Vartanian JG et al (2006) Voice and vocal self-assessment after thyroidectomy. Head Neck 28:1106–1114CrossRefGoogle Scholar
  4. 4.
    Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay MJ, Coppit GL, Shriver CD, Solomon NP (2008) Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia. Surgery 143:732–742CrossRefGoogle Scholar
  5. 5.
    Scerrino G, Inviati A, Di Giovanni S et al (2013) Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results. Otolaryngol Head Neck Surg 148:926–932CrossRefGoogle Scholar
  6. 6.
    Lombardi CP, Raffaelli M, D’Alatri L et al (2006) Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 140:1026–1032 discussion 1032-1024 CrossRefGoogle Scholar
  7. 7.
    Lombardi CP, Raffaelli M, De Crea C et al (2009) Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery 146:1174–1181CrossRefGoogle Scholar
  8. 8.
    Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS, Kim TW (2012) Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 26:1871–1877CrossRefGoogle Scholar
  9. 9.
    Maeda T, Saito M, Otsuki N, Morimoto K, Takahashi M, Iwaki S, Inoue H, Tomoda C, Miyauchi A, Nibu KI (2013) Voice quality after surgical treatment for thyroid cancer. Thyroid 23:847–853CrossRefGoogle Scholar
  10. 10.
    Lombardi CP, Raffaelli M, D’Alatri L et al (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32:693–700CrossRefGoogle Scholar
  11. 11.
    Kark AE, Kissin MW, Auerbach R, Meikle M (1984) Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J 289:1412–1415CrossRefGoogle Scholar
  12. 12.
    Helidoni ME, Murry T, Moschandreas J, Lionis C, Printza A, Velegrakis GA (2010) Cross-cultural adaptation and validation of the voice handicap index into Greek. J Voice 24:221–227CrossRefGoogle Scholar
  13. 13.
    Jacobson BHJA, Grywalski C et al (1997) The Voice Handicap Index (VHI): development and validation. Am J Speech Lang Pathol 6:66–70CrossRefGoogle Scholar
  14. 14.
    Silva IC, Netto Ide P, Vartanian JG, Kowalski LP, Carrara-de AE (2012) Prevalence of upper aerodigestive symptoms in patients who underwent thyroidectomy with and without the use of intraoperative laryngeal nerve monitoring. Thyroid 22:814–819CrossRefGoogle Scholar
  15. 15.
    Song CM, Yun BR, Ji YB, Sung ES, Kim KR, Tae K (2016) Long-term voice outcomes after robotic thyroidectomy. World J Surg 40:110–116CrossRefGoogle Scholar
  16. 16.
    Mohil RS, Desai P, Narayan N, Sahoo M, Bhatnagar D, Venkatachalam VP (2011) Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment—two important steps in thyroid surgery. Ann R Coll Surg Engl 93:49–53CrossRefGoogle Scholar
  17. 17.
    Wasserman JM, Sundaram K, Alfonso AE, Rosenfeld RM, Har-El G (2008) Determination of the function of the internal branch of the superior laryngeal nerve after thyroidectomy. Head Neck 30:21–27CrossRefGoogle Scholar
  18. 18.
    Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A (2003) Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy. Surgery 133:318–322CrossRefGoogle Scholar
  19. 19.
    Grover G, Sadler GP, Mihai R (2013) Morbidity after thyroid surgery: patient perspective. Laryngoscope 123:2319–2323CrossRefGoogle Scholar
  20. 20.
    Holler T, Anderson J (2014) Prevalence of voice and swallowing complaints in preoperative thyroidectomy patients: a prospective cohort study. J Otolaryngol Head Nrck Surg 43:28.  https://doi.org/10.1186/s40463-014-0028-4 CrossRefGoogle Scholar
  21. 21.
    Lombardi CP, D'Alatri L, Marchese MR et al (2012) Prospective electromyographic evaluation of functional postthyroidectomy voice and swallowing symptoms. World J Surg 36:1354–1360CrossRefGoogle Scholar
  22. 22.
    Nasiri S, Shafag S, Khorgami Z, Sodagari N, Aminian A, Hedayat A (2013) Does corticosteroid have any beneficial effect on voice change after thyroidectomy? Am Surg 79:1258–1262Google Scholar
  23. 23.
    Lachanas VA, Exarchos S, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE, Bizakis JG (2014) Does perioperative dexamethasone affect voice-related quality of life after thyroidectomy? Eur Arch Otorhinolaryngol 271:3073–3076CrossRefGoogle Scholar
  24. 24.
    Worni M, Schudel HH, Seifert E, Inglin R, Hagemann M, Vorburger SA, Candinas D (2008) Randomized controlled trial on single dose steroid before thyroidectomy for benign disease to improve postoperative nausea, pain, and vocal function. Ann Surg 248:1060–1066CrossRefGoogle Scholar
  25. 25.
    Vicente DA, Solomon NP, Avital I, Henry LR, Howard RS, Helou LB, Coppit GL, Shriver CD, Buckenmaier CC, Libutti SK, Shaha AR, Stojadinovic A (2014) Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment. J Am Coll Surg 219:152–163CrossRefGoogle Scholar
  26. 26.
    Sabaretnam M, Mishra A, Chand G, Agarwal G, Agarwal A, Verma AK, Mishra SK (2012 Jun) Assessment of swallowing function impairment in patients with benign goiters and impact of thyroidectomy: a case control study. World J Surg 36(6):1293–1299CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  1. 1.Department of Otorhinolaryngology, University Hospital of LarissaUniversity of ThessalyLarissaGreece
  2. 2.Department of Surgery, University Hospital of LarissaUniversity of ThessalyLarissaGreece

Personalised recommendations