Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment

Abstract

Voice symptoms are frequently reported early after thyroidectomy, even in the absence of laryngeal nerves injury. We evaluated the short-term outcomes of these functional alterations. Thirty-nine patients were enrolled in a prospective observational trial, evaluating voice function before and 3 months after uncomplicated thyroidectomy, using VoiSS as assessed using a validated patient rated questionnaire; and perceptual voice analysis using GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain). Impact of dysphonia on patient's life using VoiSS questionnaire revealed differences between pre- and postoperative assessment. There was statistically significant worsening in the impairment subgroup of VoiSS (p = 0.027). GRBAS evaluation was consistent between the three independent raters but showed differences between pre- and postoperative voice assessment. Age, TSH and a preoperative finding of laryngopharyngeal reflux significantly predicted quality of voice after thyroid surgery (all p < 0.004), as identified by the GRBAS assessment tool, but not type of surgery, gender or smoking status; although prediction of total variance in changes of voice was modest (r = 0.07). Voice changes may occur after thyroidectomy without evident laryngeal nerve injury. Patients should be made aware of possible mild changes in voice even after uncomplicated thyroid surgery and this might be considered to be part of the informed consent.

Patient Perception of Swallowing after Thyroidectomy in the Absence of Laryngeal Nerve Injury

“…It is suggested that patients should be advised of the possibility of vocal changes prior to surgery, regardless of the occurrence of laryngeal nerve damage during thyroidectomy, a suggestion also made by Tedla et al (2016) [33]. In addition to the guidelines on vocal aspects, the present study also reveals the importance of orienting patients regarding swallowing aspects, as several studies, including the present study, indicate that there is a possibility of dysphagia in this population [6,28,29,31,38,39].…”

“…Furthermore, there is significant variability in the methods employed, especially with regard to the most adequate period for performing the evaluations [8,13,27,28]. It is evident that, regardless of how long after surgery the postoperative evaluation occurs -2 h; 1 day; on the 7th, 12th, or 60th day; 1, 3, or 6 months; or 4 years [6,15,24,27,29,[30][31][32][33][34][35] -the presence of upper airway, vocal and/or swallowing sensory disorders is found, suggesting that this alteration is not directly related to the existence of complications due to intubation, although Peppard and Dickens (1983) [36] and Pereira et al (2003) [24] reported that swallowing function can be altered due to the modification of the sensitivity of the intraoral, pharyngeal, and laryngeal region resulting from intubation.…”

Long-term esophageal motility changes after thyroidectomy: associations with aerodigestive disorders

“…The aerodigestive disorders associated with uncomplicated thyroidectomy are reported in several studies (2,(12)(13)(14). As commonly observed, they can also precede the surgery, and, in some cases, they can be explained as a consequence of the thyroid disease (3).…”

“…Symptoms such as hoarseness, sensation of a "lump", a "tootightly buttoned shirt collar", a "foreign body", "beeing strangled", "obstacle during swallowing" or cough are frequently described after thyroidectomy, even in absence of evident laryngeal nerve damage (12)(13)(14)(15). Several causes have been assumed to explain the association between thyroidectomy and voice and swallowing disorders.…”

Laryngeal cancer management: Voice, communication and quality of life outcomes following non-surgical treatment

“…The VoiSS is 30-item questionnaire that yields a score from 1 to 120, where, conversely, a higher score reflects a more dysphonic voice and a poorer voice-related quality of life (Deary, Wilson, Carding, & MacKenzie, 2003). Both assessment tools have been widely used within the general voice literature (including non-organic voice impairment) however have not been used extensively within the laryngeal cancer literature specifically (Greulich, Parker, Lee, Merati, & Misono, 2015;Nixon, Ramsay, & Mackenzie, 2010;Paleri, Carding, Drinnan, Kelly, & Welch, 2010;Tedla, Chakrabarti, Suchankova, & Weickert, 2016;.…”