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Prospective functional voice assessment in patients undergoing thyroid surgery.
Alexander Stojadinovic1, Ashok R Shaha, Robert F Orlikoff
1Department of Surgery, Walter Reed Army Medical Center, Washington, D.C., USA.
Annals of Surgery
|November 28, 2002
Summary
Thyroidectomy often causes early voice changes in 30% of patients, with 14% experiencing persistent issues. Objective voice alterations, not just nerve injury, predict these vocal disturbances.
Area of Science:
- Otolaryngology
- Speech-Language Pathology
- Surgical Outcomes
Background:
- Post-thyroidectomy voice disturbances are common but not well-characterized, especially in patients with normal preoperative voice and preserved laryngeal nerve function.
- Understanding the natural history of voice changes is crucial for effective postoperative voice rehabilitation.
Purpose of the Study:
- To analyze voice function changes before and after thyroidectomy in patients with normal preoperative voice.
- To identify objective voice parameters and their correlation with subjective voice symptoms post-thyroidectomy.
Main Methods:
- Prospective single-arm study involving functional voice testing (acoustic, aerodynamic, glottographic, videostroboscopic) in 54 patients.
- Voice assessments were conducted preoperatively, 1 week postoperatively, and 3 months postoperatively.
- Statistical analysis included ANCOVA, t-tests, Fisher exact, and chi-square tests.
Main Results:
- No recurrent laryngeal nerve injury; one superior laryngeal nerve injury.
- 30% reported early and 14% reported late (3-month) subjective voice changes.
- 84% showed objective voice changes; multiple objective changes correlated with persistent symptoms and predicted late vocal changes.
Conclusions:
- Early vocal symptoms post-thyroidectomy are frequent, with 14% experiencing persistent changes.
- Objective voice alterations, particularly in maximum phonational frequency range and vocal jitter, predict late vocal symptoms.
- Factors beyond laryngeal nerve injury contribute to post-thyroidectomy dysphonia, highlighting the need for further research into voice physiology.