Vocal foldparesis as a surgical complication: Our 10‐year experience with 162 incidents

Heikkinen, Maria; Halttunen, Svantte; Terävä, Markku; Kärkkäinen, Jussi M.; Löppönen, Heikki; Penttilä, Elina

doi:10.1111/coa.13251

Cited by 3 publications

(6 citation statements)

References 10 publications

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“…Vocal fold paresis or paralysis (VFP) caused by recurrent laryngeal nerve damage is a major complication of thyroid and parathyroid surgery, and it may inflict a lifelong handicap. VFP incidence may be up to 14%, [1][2][3][4] averaging at 5% in most institutions. 1,[3][4][5][6][7][8][9][10] To detect a possible VFP after surgery, laryngoscopy is the gold standard diagnostic method.…”

Section: Introductionmentioning

confidence: 99%

“…VFP incidence may be up to 14%, [1][2][3][4] averaging at 5% in most institutions. 1,[3][4][5][6][7][8][9][10] To detect a possible VFP after surgery, laryngoscopy is the gold standard diagnostic method. However, routine pre-and postoperative laryngoscopic examinations performed on all patients undergoing surgery of the neck are time-consuming and may not be costeffective.…”

Section: Introductionmentioning

confidence: 99%

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Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

et al. 2021

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Background and Aims: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Materials and Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusion: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

et al. 2021

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“…Reasons given to support the use of pre-operative laryngoscopy are (i) to confirm in the event of a finding of post-operative vocal cord palsy (VCP) that it is indeed newly caused by the procedure and (ii) when a pre-operative VCP is identified, to raise awareness in the patient and surgeon of the risk of bilateral palsy if contralateral surgery is planned. Routine laryngoscopy prior to thyroid surgery performed on adult patients identified a 2.3–2.8% prevalence of pre-operative VCP ( Lang et al 2014 , Heikkinen et al 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Institutions that practice routine post-operative laryngoscopy report almost two times higher rates of cord palsy than those that do not ( Bergenfelz et al 2008 ). Studies that report routine post-operative vocal fold examination post thyroidectomy identify transient and permanent VCP in 5.2–12.6% and 1.1–3.3% of patients, respectively ( Lo et al 2000 , Joliat et al 2017 , Heikkinen et al 2019 ). Routine post thyroidectomy laryngoscopy in CYP has not been reported.…”

Section: Resultsmentioning

confidence: 99%

Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline

Howard

Freeston

Harrison³

et al. 2022

Endocrine-Related Cancer

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This guideline is written as a reference document for clinicians presented with the challenge of managing paediatric patients with differentiated thyroid carcinoma up to the age of 19 years. Care of paediatric patients with differentiated thyroid carcinoma differs in key aspects from that of adults, and there have been several recent developments in the care pathways for this condition; this guideline has sought to identify and attend to these areas. It addresses the presentation, clinical assessment, diagnosis, management (both surgical and medical), genetic counselling, follow-up and prognosis of affected patients. The guideline development group formed of a multi-disciplinary panel of sub-speciality experts carried out a systematic primary literature review and Delphi consensus exercise. The guideline was developed in accordance with The Appraisal of Guidelines Research and Evaluation Instrument II criteria, with input from stakeholders including charities and patient groups. Based on scientific evidence and expert opinion, 58 recommendations have been collected to produce a clear, pragmatic set of management guidelines. It is intended as an evidence base for future optimal management and to improve the quality of clinical care of Paediatric patients with differentiated thyroid carcinoma.

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“…Vocal fold paresis or paralysis (VFP) caused by recurrent laryngeal nerve injury is a well-known complication following thyroid or parathyroid surgery with incidence rates ranging from 1.4% to 38% (1)(2)(3)(4). In most institutions, the risk of postoperative VFP is roughly 5% [1,[3][4][5][6][7][8][9][10]. Postoperatively, VFP can be asymptomatic and go undetected unless routine laryngoscopy examinations are performed [11,12].…”

Section: Introductionmentioning

confidence: 99%

Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid Surgery

et al. 2020

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Background The aim of this study was to evaluate the reliability of clinician-based perceptual assessment of voice and computerized acoustic voice analysis as screening tests for vocal fold paresis or paralysis (VFP) after thyroid and parathyroid surgery. Methods This was a prospective study of 181 patients undergoing thyroid or parathyroid procedure with pre and postoperative laryngoscopic vocal fold inspection, perceptual voice assessment using grade, roughness, breathiness, asthenia, and strain (GRBAS) scale and acoustic voice analysis using the multi-dimensional voice program (MDVP). Patients were divided into 2 groups for comparison; those with new postoperative VFP and those without. Potential screening tools were evaluated using the receiving operating characteristic (ROC) analysis. Results Fourteen (6.6%) patients had a new postoperative VFP. Postoperative GRBAS scores were significantly (P < 0.05) higher in patients with VFP compared to those without. However, there were no statistically significant differences in MDVP values between the groups. Postoperative GRBAS grade score (cut off > 0) had the best sensitivity, 93%, for predicting VFP, but the specificity was only 50%. Postoperative jitter (cut off > 1.60) in MDVP had a good specificity, 90%, but only 50% sensitivity. Combining all the GRBAS and MDVP variables with P < 0.05 in the ROC analysis yielded a test with 100% sensitivity and 55% specificity. Conclusions Physician-based perceptual voice assessment has a high sensitivity for detecting postoperative VFP, but the specificity is poor. The risk of VFP is low in patients with completely normal voice at discharge. However, routine laryngoscopy after thyroid and parathyroid surgery is still the most reliable exam for VFP screening.

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Vocal foldparesis as a surgical complication: Our 10‐year experience with 162 incidents

Abstract: Vocal foldparesis as a surgical complication: Our 10-year experience with 162 incidents

Cited by 3 publications

References 10 publications

Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

Paediatric differentiated thyroid carcinoma: a UK National Clinical Practice Consensus Guideline

Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid Surgery

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