Voice changes after thyroidectomy without recurrent laryngeal nerve injury

Sinagra, Diego; Montesinos, Manuel R; Tacchi, Verónica A.; Moreno, Julio C; Falcó, Jorge; Mezzadri, Norberto A; Debonis, Daniel; Curutchet, H. Pablo

doi:10.1016/j.jamcollsurg.2004.06.020

Cited by 175 publications

(209 citation statements)

References 7 publications

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“…Slight increase in mean scores for frequency perturbation (Jitta), shimmer %, Sapq, DVB and DUV were noted. Elevated amplitude perturbation values support previous reports of [1,7]. Increased amplitude perturbation values indicate increased loudness variation.…”

Section: Discussionsupporting

confidence: 88%

“…Watt-Boolsen et al [13] also reported that 12 patients with sporadic non-toxic goiter and 8 with medically pretreated toxic goiter had impaired voice function which improved after thyroid surgery in the nontoxic goiter group but remained unchanged in the toxic goiter group. Worsening of strainness scores supports the previous findings of Sinagra et al [7]. In the absence of any demonstrable laryngeal nerve injury through videostrobolaryngoscopy, the factors that could determine increased strainness can be related to normal healing process or possibly in a small percentage of cases, to sub clinical postoperative haematoma.…”

Section: Discussionsupporting

confidence: 86%

“…Fundamental frequency related parameters give information regarding different aspects of pitch of the vocal fold behaviour. In the present study, we studied the mean F0, highest F0, lowest Previous researchers who have investigated the acoustic parameters [7,14] have reported of significant reduction in F0 and Lowest F0 and a significant increase in shimmer values. The decrease in F0 has been attributed to decrease in cordal tension by alteration in the functional character of the cricothyriod muscle or the external branch of superior laryngeal nerve [15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Operative trauma to the RLNthe most feared complication of thyroidectomy-occurs in 2-13% of patients, which in turn could lead to vocal cord paralysis and hoarseness of voice. Further, changes in voice characteristics have also been documented in the absence of laryngeal nerve injury with as many as 30% of the patients suffering from early and 14% suffering from lasting functional voice changes [1,7,11,12]. This has been attributed to other mechanical factors (strap muscle division or laryngotracheal fixation, surgical trauma to the cricothyroid muscle or cricoarytenoid joint, endotracheal intubation, etc.)…”

Section: Discussionmentioning

confidence: 99%

“…Several causes such as orotracheal intubation [5]; modification of the vascular supply and venous drainage of the larynx [6]; cricothyriod dysfunction [5][6][7]; laryngotracheal fixation with impairment of vertical movement [3,5,6,8]; strap muscle malfunction due to denervation or direct injury (section); local pain in neck; and/or a psychological reaction to the postoperative situation have been postulated. However, there is inconsistency in the cited results.…”

mentioning

confidence: 99%

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Perceptual and Acoustic Analysis of Voice in Individuals with Total Thyriodectomy: Pre-Post Surgery Comparison

Santosh

Rajashekhar

2011

Indian J Otolaryngol Head Neck Surg

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Total thyroidectomy (TT) is a surgical procedure which involves complete removal of the thyroid gland, usually done in massive goitre compressing the trachea and esophagus, hyperthyroidism and carcinoma of thyroid gland. Laryngeal nerve damage is one of the most feared complications after TT which can lead to permanent changes in voice. Recent research suggests the occurrence of voice changes without any visible laryngeal nerve damage. Present study attempts to compare the pre and post-operative voice characteristics in individuals with total thyroidectomy without any laryngeal nerve damage. A total of 27 subjects (21 females and 6 males) who underwent total thyroidectomy participated in the study. Their recorded phonation of vowel/a/was subjected to two types of analyses viz. Perceptual analysis (using CAPE-V rating scale) and Acoustic analysis (using Multi Dimensional Voice Profile). Results of perceptual analysis indicated slight decrease in overall severity, roughness and breathiness and a slight increase in strainness, in only males. Acoustic analysis findings supported perceptual results with minimal changes in most of the parameters. The results suggest that after total thyroidectomy, in the absence of visible laryngeal nerve damage, functional changes in voice are minimal and temporary in nature. This study provides an insight to Otolaryngologists and Speech Language Pathologists about the voice characteristics in individuals with thyroidectomy, enabling them to formulate appropriate therapy protocol for this population. It further attempts to sensitize surgeons and physicians on the need for referral of this population to Speech Language Pathologist in the event of dysphonia.Keywords Total thyroidectomy Á Perceptual analysis Á Acoustical analysis Á Laryngeal nerve damage Total thyroidectomy (TT) is one of the surgical options for individuals with thyroid problems. This procedure involves complete removal of the thyroid gland and is usually done in cases of massive goitre compressing the trachea and esophagus, in cases of hyperthyroidism or carcinoma of thyroid gland. The intricate and delicate anatomic structures for voice production lie in close proximity to thyroid gland and are vulnerable during operations on the thyroid.Complications subsequent to TT may range from minor (post operative seroma) to major ones (injury to laryngeal nerve). Injury to laryngeal nerve can be either due to injury to external branch of superior laryngeal nerve (SLN) or recurrent laryngeal nerve (RLN). Reported risk of SLN injury varies from 0.3 to 13% [1]. The estimated frequency of RLN injury fluctuates between 5 and 10%, of which 5% are temporary and between 0.8 and 1.7% are permanent [2].Voice changes due to SLN and RLN injury may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. Typical voice symptoms after surgery are vocal fatigue during phonation and with high pitch and singing voice [3]. People with injury to...

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 86%