The Long‐Term Prognosis of Voice Pitch Change in Female Patients After Thyroid Surgery

Park, Jun‐Ook; Bae, Ja-Sung; Lee, So Hee; Shim, Mi‐Ran; Hwang, You Mi; Joo, Young‐Hoon; Park, Young Hak; Sun, Dong‐Il

doi:10.1007/s00268-016-3511-4

Cited by 19 publications

(13 citation statements)

References 47 publications

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“…Among the patients with subjective HPVI, there were significantly more female patients. Females may be more likely to notice a change to a higher voice pitch, and males may be more likely to ignore it; a similar finding was also described by Park et al (12) Acquiescence bias is a category of response bias in which respondents have a tendency to choose a positive response option (23), and approximately 10% to 20% of respondents exhibit this behavior (24). In our study, the IVST-S of the subjective HPVI patients had a higher value than that for any of the objective HPVI groups.…”

Section: Discussionsupporting

confidence: 79%

“…The cricothyroid muscle (CTM) innervated by the EBSLN can lengthen the vocal fold and increase the fundamental frequency of vocal fold vibration to produce a higher-pitched voice; thus, many studies have focused on the relationship between the EBSLN and HPVI (9,10). However, there are more studies that support the finding that HPVI can frequently appear in patients without RLN or EBSLN injury (11)(12)(13). After thyroidectomy, fibrosis may form between the strap muscles and laryngotracheal unit and impair the vertical movement (14), and may form in lateral extralaryngeal muscles when overtraction during the surgery.…”

Section: Introductionmentioning

confidence: 99%

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

Huang

Chiang

et al. 2021

Front. Endocrinol.

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ObjectivesHigh-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery.MethodsThis study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient’s answers on the IVST.ResultsAs the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV.ConclusionThe factors that affect a patient’s subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.

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Section: Discussionsupporting

confidence: 79%

Section: Introductionmentioning

confidence: 99%

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

Huang

Chiang

et al. 2021

Front. Endocrinol.

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“…Thyroid lobectomy is associated with fewer complications (hypoparathyroidism, recurrent laryngeal nerve injury resulting in hoarseness, or tracheostomy), less use of thyroid hormone, and superior health-related quality of life (14)(15)(16). This has raised the concern that in patients with low-risk differentiated thyroid cancer, traditional treatment with total thyroidectomy might result in harm without added benefit.…”

Section: Introductionmentioning

confidence: 99%

Patient Preferences Around Extent of Surgery in Low-Risk Thyroid Cancer: A Discrete Choice Experiment

Ahmadi

Gonzalez²,

Talbott³

et al. 2020

Thyroid

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Background: Patient preferences pertaining to surgical options for thyroid cancer management are not well studied. Our aim was to conduct a discrete choice experiment (DCE) to characterize participants' views on the relative importance of various risks and benefits associated with lobectomy versus total thyroidectomy for lowrisk thyroid cancer. Methods: Adult participants with low-risk thyroid cancer or a thyroid nodule requiring surgery were asked to choose between experimentally designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), hypocalcemia (0%, 3%, 8%), risk of needing a second surgery (0%, 40%), cancer recurrence (1%, 3%, 5%), and need for daily thyroid hormone supplementation (yes, no). Their choices were analyzed using randomparameters logit regression. Results: One hundred fifty participants completed an online DCE survey. Median age was 58 years; 82% were female. Twenty-four participants (16%) had a diagnosis of thyroid cancer at the time of completing the survey, and 126 (84%) had a thyroid nodule necessitating surgery. On average, 35% of participants' choices were explained by differences in the risk of cancer recurrence; 28% by the chance of needing a second surgery; 19% by the risk of nerve damage; and 9% by differences in risks of hypocalcemia and the need for thyroid hormone supplementation. When accounting for differences in postoperative risks, the average patient favored lobectomy over total thyroidectomy as long as the chance of needing a second (i.e., completion) surgery after initial lobectomy remained below 30%. Participants would accept a 4.1% risk of cancer recurrence if the risk of a second surgery could be reduced from 40% to 10%. Conclusions: While patients with thyroid cancer may have clear preferences for extent of surgery, common themes moderating preferences for surgical interventions were identified in the DCE. Adequate preoperative evaluation to decrease the chance of a second surgery and providing patients with a good understanding of risks and benefits associated with extent of surgery can lead to better treatment decision-making.

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“…Changes in all patients were calculated (postoperative change in SFF, ΔSFF = preoperative value of SFF – postoperative value of SFF, Hz). If the ΔSFF was > 12 Hz, the patient was considered to have a lower-pitched voice [ 12 , 13 , 21 ]. The software defines jitter values up to N < 1.1% and shimmer values up to N < 3.8% as normal.…”

Section: Methodsmentioning

confidence: 99%

Can Voice Pitch Be Preserved in Patients after Transoral Endoscopic Thyroidectomy Vestibular Approach?

Kim

Park

et al. 2020

JCM

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Introduction: Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has become increasingly popular. Several reports have emphasized the safety and efficacy of this new approach. However, there is no report on functional voice outcomes, including voice pitch change after TOETVA. Methods: The functional voice outcomes of patients undergoing TOETVA were compared with those of patients undergoing conventional thyroidectomy. A total of 82 consecutive patients were included in the study: 44 underwent thyroid lobectomy via TOETVA (transoral group) and 38 underwent thyroid lobectomy via the classic cervical approach (open group). Thyroidectomy-related voice questionnaire (TVQ), perceptual voice analysis, fiberoptic laryngoscopic and videolaryngostroboscopic examinations, and acoustic analysis were carried out before and one month after surgery. The changes in these values after surgery and the differences between the transoral and open groups were analyzed. Results: We found no significant postoperative change in voice workups in either group. The mean high pitch decreased (from 367.91 ± 120.98 to 325.80 ± 100.86 Hz, p = 0.069) in the transoral group, but statistical significance was not attained. Clinically significant changes in pitch (postoperative change in speaking fundamental frequency, ΔSFF ≥ 12) after surgery were evident in seven (15.91%) patients in the transoral group and eight (21.05%) patients in the open group without significant difference (p = 0.579). Conclusions: This is the first study to assess functional voice outcomes (including pitch) after TOETVA compared with conventional open surgery. TOETVA was associated with good voice outcomes without any significant drop in pitch.

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The Long‐Term Prognosis of Voice Pitch Change in Female Patients After Thyroid Surgery

Cited by 19 publications

References 47 publications

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

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

Patient Preferences Around Extent of Surgery in Low-Risk Thyroid Cancer: A Discrete Choice Experiment

Can Voice Pitch Be Preserved in Patients after Transoral Endoscopic Thyroidectomy Vestibular Approach?

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