SUMMARY
Objective
Vocal dysfunction is one of the major factors that affect the health-related quality
of life of patients after thyroidectomy. Conventionally, voice changes after thyroidectomy
have been evaluated by videostroboscopy and acoustic analysis. Recently, two-dimensional
scanning digital kymography (2D DKG) and high-speed videolaryngoscopy (HSV) have been
developed and have shown usefulness in accurately evaluating vocal fold vibration.
This study aimed to evaluate changes of vocal fold vibration and voice after thyroidectomy
using 2D DKG and HSV.
Materials and Methods
We evaluated the voice and vocal fold movement of 24 female patients who underwent
thyroidectomy in a single tertiary hospital from December 2018 to October 2019. We
obtained serial 2D DKG and HSV data one day before thyroidectomy, and 1 week and 1
month after surgery. We analyzed the peak glottal area of HSV, amplitude symmetry
index, phase symmetry index, and open quotient using the 2D DKG data. The parameters
were calculated at three levels of the vocal fold (line 1=anterior, line 2=middle,
line 3=posterior). In the same period, we performed a voice analysis evaluating voice
frequency, jitter, shimmer, and noise to harmonic ratio. We also assessed maximum
phonation time and subjective voice changes with voice handicap index-10 questionnaires.
Results
Highest frequency (F-high), frequency range (F-range), and fundamental frequency (F0)
decreased at 1 week and 1 month after thyroidectomy compared with preoperative values
(P = 0.003, 0.004, <0.001 and P = 0.002, 0.015, 0.001 at 1 week and 1 month, respectively). The open quotient of
2D DKG in lines 1 and 2 increased at 1 week after thyroidectomy (P = 0.011, 0.006) and recovered to preoperative levels at 1 month postoperatively (P = 0.189, 0.153). Other quantitative measures by 2D DKG and HSV did not show significant
changes between the preoperative and postoperative periods. In a correlation analysis
between vocal parameters from the acoustic analysis and the values obtained from 2D
DKG and HSV, significant negative correlations were observed between peak glottal
area and three factors (F-high, F-range, and F0) at 1 month after surgery (r = -0.589,
-0.529, -0.708; P = 0.002, 0.008, <0.001, respectively). There were positive correlations between phase
symmetry indexes in lines 1 and 2 and shimmer at 1 week after thyroidectomy (r = 0.489,
0.425; P = 0.015, 0.038, respectively). Phase symmetry index in line 3 showed a significant
negative correlation with maximum phonation time at both 1 week and 1 month after
surgery (r = -0.497, -0.439; P = 0.013, 0.032, respectively). However, there was no correlation between total score
on the voice handicap index-10 questionnaires and quantitative measurements of vocal
fold vibration.
Conclusion
2D DKG and HSV may provide important information on vocal fold vibratory patterns
after thyroidectomy, and measurements made with them were correlated with maximal
phonation time and acoustic parameters such as F-high, F-range, F0, shimmer.
KEY WORDS
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Article info
Publication history
Published online: February 01, 2021
Accepted:
January 7,
2021
Identification
Copyright
© 2021 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
