Change of Voice Parameters After Thyroidectomy Without Apparent Injury to the Recurrent Laryngeal or External Branch of Superior Laryngeal Nerve: A Prospective Cohort Study
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Background and Objectives The quality of life after thyroidectomy, such as voice change, is considered to be as important as control of the disease. In this study, we aimed to evaluate changes in both subjective and objective voice parameters after thyroidectomy resulting in normal morbidity of the vocal cords.Materials and Method In this prospective cohort study, 204 patients who underwent thyroidectomy with or without central neck dissection at a single referral center from Feb 2015 to Aug 2016 were enrolled. All patients underwent prospective voice evaluations including both subjective and objective assessments preoperatively and then at 2 weeks, 3, 6, and 12 months postoperatively. Temporal changes of the voice parameters were analyzed.Results Values of the subjective assessment tool worsened during the early postoperative follow-up period and did not recover to the preoperative values at 12 months postoperatively. The maximal phonation time gradually decreased, whereas most objective parameters, including maximal vocal pitch (MVP), reached preoperative values at 3–6 months postoperatively. The initial decrease in MVP was significantly greater in patients undergoing total thyroidectomy, and their MVP recovery time was faster than that of patients undergoing lobectomy (p=0.001). Patients whose external branch of the superior laryngeal nerve was confirmed intact by electroidentification showed no difference in recovery speed compared with patients without electroindentification (p=0.102), although the initial decrease in MVP was lower with electroidentification.Conclusion Subjective assessment in voice quality and maximal phonation time after thyroidectomy did not show recovery to preoperative values. Aggravation of MVP was associated with surgical extent and electroidentification.
Abstract
Background and Objectives The quality of life after thyroidectomy, such as voice change, is considered to be as important as control of the disease. In this study, we aimed to evaluate changes in both subjective and objective voice parameters after thyroidectomy resulting in normal morbidity of the vocal cords.Materials and Method In this prospective cohort study, 204 patients who underwent thyroidectomy with or without central neck dissection at a single referral center from Feb 2015 to Aug 2016 were enrolled. All patients underwent prospective voice evaluations including both subjective and objective assessments preoperatively and then at 2 weeks, 3, 6, and 12 months postoperatively. Temporal changes of the voice parameters were analyzed.Results Values of the subjective assessment tool worsened during the early postoperative follow-up period and did not recover to the preoperative values at 12 months postoperatively. The maximal phonation time gradually decreased, whereas most objective parameters, including maximal vocal pitch (MVP), reached preoperative values at 3–6 months postoperatively. The initial decrease in MVP was significantly greater in patients undergoing total thyroidectomy, and their MVP recovery time was faster than that of patients undergoing lobectomy (p=0.001). Patients whose external branch of the superior laryngeal nerve was confirmed intact by electroidentification showed no difference in recovery speed compared with patients without electroindentification (p=0.102), although the initial decrease in MVP was lower with electroidentification.Conclusion Subjective assessment in voice quality and maximal phonation time after thyroidectomy did not show recovery to preoperative values. Aggravation of MVP was associated with surgical extent and electroidentification.
참고문헌 (20)
- Canaris GJ, "The Colorado thyroid disease prevalence study", Arch Intern Med, 160(4), pp.526~534 (2000)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2009", Cancer Research and Treatment, 44(1), pp.11~24 (2012), 대한암학회
- Ryu J, "Extent of thyroidectomy affects vocal and throat functions : A prospective observational study of lobectomy versus total thyroidectomy", Surgery, 154(3), pp.611~620 (2013)
- Debruyne F, "Acoustic analysis of the speaking voice after thyroidectomy", J Voice, 11(4), pp.479~482 (1997)
- de Pedro Netto I, "Voice and vocal self-assessment after thyroidectomy", Head Neck, 28(12), pp.1106~1114 (2006)
- Lombardi CP, "Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries", Surgery, 140(6), pp.1026~1032 (2006)
- Sinagra DL, "Voice changes after thyroidectomy without recurrent laryngeal nerve injury", J Am Coll Surg, 199(4), pp.556~560 (2004)
- Stojadinovic A, "Prospective functional voice assessment in patients undergoing thyroid surgery", Ann Surg, 236(6), pp.823~832 (2002)
- Grover G, "Morbidity after thyroid surgery : Patient perspective", Laryngoscope, 123(9), pp.2319~2323 (2013)
- Lang BH, "A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy", Laryngoscope, 126(2), pp.528~537 (2016)
- Teitelbaum BJ, "Superior laryngeal nerve injury from thyroid surgery", Head Neck, 17(1), pp.36~40 (1995)
- Soylu L, "The evaluation of the causes of subjective voice disturbances after thyroid surgery", Am J Surg, 194(3), pp.317~322 (2007)
- Kark AE, "Voice changes after thyroidectomy: Role of the external laryngeal nerve", Br Med J(Clin Res Ed), 289(6456), pp.1412~1415 (1984)
- Chandrasekhar SS, "Clinical practice guideline : Improving voice outcomes after thyroid surgery", Otolaryngol Head Neck Surg, 148(6 Suppl), pp.S1~S37 (2013)
- Lee DY, "Analysis of temporal change in voice quality after thyroidectomy : Single-institution prospective study", J Voice, 31(2), pp.195~201 (2017)
- Ziwei Y, "Multiparameter voice assessment for voice disorder patients : A correlation analysis between objective and subjective parameters", J Voice, 28(6), pp.770~774 (2014)
- Lombardi CP, "Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms", Surgery, 146(6), pp.1174~1181 (2009)
- Lee J, "Postoperative functional voice changes after conventional open or robotic thyroidectomy : A prospective trial", Ann Surg Oncol, 19(9), pp.2963~2970 (2012)
- Randolph GW, "Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery : International standards guideline statement", Laryngoscope, 121(Suppl 1), pp.S1~S16 (2011)
- Baek SK, "Efficiency of intraoperative neuromonitoring on voice outcomes after thyroid surgery", Auris Nasus Larynx, 44(5), pp.583~589 (2017)