Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery

Abstract

Objectives: This study is set to analyze clinicopathological factors predicting the recovery of unilateral vocal fold paralysis (UVP) in patients after thyroid gland surgery. The quality of voice was additionally assessed in these patients. Methods: The charts and videolaryngostroboscopy (VLS) examinations of 84 consecutive patients with a complete UVP after surgery of the thyroid gland were retrospectively reviewed. Patients were divided into 2 groups: patients who fully recovered from vocal fold paralysis and those who failed to recover after a follow-up of 12 months. The quality of voice was analyzed among other things by determining the Voice Handicap Index (VHI). Results: The UVP fully recovered in 52 of 84 (61.9%) patients. Positive mucosal waves (pMWs) on the paralyzed side, a minimal glottic gap <3 mm seen at the first postoperative VLS, age ≤50 years, and surgery duration ≤120 minutes were associated factors for a complete recovery of nerve function. The voice parameters improved independently from recovery of the paralysis in 90% of the patients. Conclusions: For patients with a poor prognosis of a UVP, early intervention may be beneficial. Thus, predicting factors for a full recovery of vocal fold motion would be a valuable tool. In our cohort, about 60% of recoveries could have been predicted using the above-mentioned parameters. Good quality of voice was independently reached in 90% of the cases.

Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters

“…Some of the patients who revealed asymmetric VFM under laryngofiberscopy still had good subjective voice performance, which has been mentioned previously (27,28). Reiter et al (29) reported that voice parameters did not significantly differ between patients with and patients without recovery from vocal cord paralysis at the end of a 12-month follow up. In the current study, the R Group and the U Group did not significantly differ in objective or subjective voice parameters in all follow-up periods.…”

“…Reiter et al. ( 29 ) reported that voice parameters did not significantly differ between patients with and patients without recovery from vocal cord paralysis at the end of a 12-month follow up. In the current study, the R Group and the U Group did not significantly differ in objective or subjective voice parameters in all follow-up periods.…”

Is There Any Reliable Predictor of Functional Recovery Following Post‐thyroidectomy Vocal Fold Paralysis?

“…Published studies on laryngoscopy findings, predicting recovery of VFM, following thyroid operations are scarce. In a study by Reiter et al [21], the authors identify positive mucosal waves on the paralyzed side and a minimal glottic gap \ 3 mm seen at the first post-operative examination as positive predictive factors for recovery, while Choi et al [32] report the absence of compensatory movement of the normal side on videostroboscopy as an independent prognostic factor. None of the above studies included [32] or managed to correlate [21] IONM results and FFL findings to predict progression of transient VFP to permanent.…”

How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

“…Although postoperative subjective voice impairments due to RLN paralysis usually improve over time, they may not return to normal [ 34 ]. Since early intervention confers a large benefit in patients with incomplete compensation [ 35 ], comprehensive voice assessment is mandatory, and voice therapy and interventions should be performed no longer than six–12 weeks after surgery.…”