Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery

Area of Science:

• Otolaryngology
• Speech-Language Pathology
• Thyroid Surgery Outcomes

Background:

• High-pitched voice impairment (HPVI) can occur after thyroidectomy even without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury.
• Evaluating the relationship between patient-reported voice issues and objective vocal measurements is important for understanding HPVI.

Purpose of the Study:

• To assess the correlation between subjective and objective measures of high-pitched voice impairment (HPVI) in patients following thyroid surgery.
• To identify factors associated with subjective HPVI and its persistence post-thyroidectomy.

Main Methods:

• Analyzed 775 patients undergoing neuromonitored thyroidectomy with normal nerve function.
• Utilized Multi-dimensional voice program, voice range profile, and Index of Voice and Swallowing Handicap of Thyroidectomy (IVST) preoperatively and postoperatively.
• Categorized objective HPVI by maximum frequency (Fmax) decrease and evaluated subjective HPVI via IVST scores.

Main Results:

• Increased objective HPVI severity correlated with bilateral surgery and subjective HPVI (p<0.001).
• Patients with subjective HPVI were more likely to have undergone bilateral surgery and central neck dissection.
• Subjective HPVI showed similar Fmax trends to mild objective HPVI but higher Jitter, Shimmer, and IVST scores, persisting long-term.

Conclusions:

• Voice stability (Jitter, Shimmer) is as critical as maximum frequency (Fmax) in subjective HPVI post-thyroid surgery.
• Abnormal voice stability warrants consideration in patients with subjective HPVI despite normal Fmax.
• Collaborative efforts between surgeons and speech-language pathologists are essential for early HPVI identification and management.