Voice quality preservation in thyroid surgery with neuromonitoring

Wojtczak, Beata; Sutkowski, Krzysztof; Kaliszewski, Krzysztof; Forkasiewicz, Zdzisław; Knychalski, Bartłomiej; Aporowicz, Michał; Bolanowski, Marek; Barczyński, Marcin

doi:10.1007/s12020-018-1614-4

Cited by 13 publications

(8 citation statements)

References 33 publications

(52 reference statements)

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“…A partial scoring (0-40 points) for each one of the three subscales and one total score (0-120 points) is obtained (20). A total score between 0 and 30 reflects minimal handicap due to a voice problem; 31-60 is moderate and 61-120 is severe (21).…”

Section: Methodsmentioning

confidence: 99%

“…20 A total score between 0 and 30 reflects minimal handicap due to a voice problem; 31-60 is moderate and 61-120 is severe. 21 Two weeks after surgery, patients with postoperative VFP and 20 randomly selected control patients underwent a second voice recording, which was performed by a speech and language therapist at the Department of Phoniatrics. The voice samples were simultaneously recorded using the iPad system and a condenser microphone compatible with MDVP software, to validate the voice recording method used in this study.…”

Section: Methodsmentioning

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: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

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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“…To explain this large number of patients with altered voices but functional nerves according to the neuromonitoring, several reasons could be put forward (that can be limitations of our study). The combination of subjective and objective variables to detect impaired voices further improved sensitivity, compared to other studies using only subjective evaluation criteria may be one possible explanation [2,8,12,13]. The short time between surgery and postoperative ENT evaluation at 3 months also overestimated the percentage of post-thyroid vocal impairment.…”

Section: Discussionmentioning

confidence: 86%

“…Very few studies presented results with intraoperative monitoring of lower and upper laryngeal nerves in such a population with subjective and objective evaluation criteria [12][13][14]. Grouping three scores including subjective and objective evaluation variables allowed us to prioritize sensitivity to specificity.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Voice Changes of Patients after Thyroidectomy Without Inferior and Superior Laryngeal Nerves Injury According to the Intraoperative Neuromonitoring

Buiret¹,

Guillemaud²,

Fieux³

et al. 2021

JCO

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Objectives: to assess voice changes of patients after thyroidectomy without inferior and superior laryngeal nerves injury according to the intraoperative neuromonitoring. Material and methods: This monocentric study included all patients who underwent thyroidectomy with laryngeal nerves neuromonitoring between September, 2018 and December, 2019. The voice assessment was performed 1 month before and 3 months after surgery. It was both subjective (with Voice Handicap Index 10 and GRBAS scale) and objective (Dysphonia Severity Index). Voice was considered impaired if there was an increase ≥ 4 points of the Voice Handicap Index 10 score or ≥ 1 point of the GRBAS scale score or a decrease ≥ 2 points of the Dysphonia Severity Index score between the two vocal assessments. A composite score was created, combining both subjective and objective scores. Predictive factors of altered voice were seek. Results: Fifty-nine patients were analyzed. Mean Voice Handicap Index 10 varied from 3.39 ± 5.40 to 2.90 ± 5.29 (p = 0.62) before and after the surgery respectively, mean GRBAS from 0.64 ± 0.76 to 0.73 ± 0.85 (p = 0.57) and mean Dysphonia Severity Index from 8.47 ± 1.15 to 8.31 ± 1.03 (p = 0.42). Voice impairment composite score identified 14 patients with an impaired voice (23.7%). Age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment. Conclusions: the voice quality 3 months after thyroidectomy was not significantly subjectively and objectively changed compared to before thyroidectomy. When grouping voice impairment scores, age ≥65 years, preoperative Voice Handicap Index 10 score ≥ 3 and thyroidectomy past history were independent risk factors of voice impairment.

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“…Patients with unilateral recurrent laryngeal nerve palsy may not have serious respiratory difficulties; however, some problems with voice quality and hoarseness might be observed. 37 Some previous studies showed no significant differences in the complication rates and postsurgical calcium levels between OT and "modern" techniques. 38,39 Surgeons' experience using RT and ET has become sufficient to produce a low complication rate and very high oncological efficacy rate.…”

Section: Postsurgical Complicationsmentioning

confidence: 90%

Thyroid cancer surgery – in what direction are we going? A mini-review

et al. 2020

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The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally invasive procedures for treating thyroid disease have been established in recent decades. Total endoscopic and robotic procedures have been slowly and successively introduced while meeting all oncological criteria. Our analysis of the advantages and disadvantages of scarless surgical procedures suggests that the cosmetic aspects of these surgeries will continue to become more important. This review assesses the recent findings regarding the roles of endoscopic and robotic procedures in thyroid cancer surgery.

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Voice quality preservation in thyroid surgery with neuromonitoring

Cited by 13 publications

References 33 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

Assessment of Voice Changes of Patients after Thyroidectomy Without Inferior and Superior Laryngeal Nerves Injury According to the Intraoperative Neuromonitoring

Thyroid cancer surgery – in what direction are we going? A mini-review

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