Summary
Objective
The aim of the study was to evaluate voice and swallowing function following thyroid
surgery, to identify dynamic changes during the follow-up period of 12-18 month and
to find possible indicative signs of permanent or temporary vocal fold palsy.
Methods
All participants (N = 110) were prospectively enrolled from the preoperative thyroid surgery patients
between September 2013 and December 2016. All subjects underwent preoperatively, first
week and 12-18 month postoperatively videolaryngostroboscopy, filled in subjective
evaluation of voice (voice handicap index, [VHI]) and swallowing (swallowing impairment
score) complaints. Acoustic voice analysis (AVA), maximum phonation time (MPT) measurement
and perceptual voice evaluation were conducted. In the presence of laryngeal damage,
additional first and sixth-month follow-up visits were planned. Patients, whom we
suspected laryngeal nerve damage, underwent laryngeal electromyography 4 weeks after
the operation.
Results
On first postoperative week evaluation, no objective voice changes within patients
with postoperatively intact laryngeal nerves were found. Subjective evaluations showed
decline in VHI physical domain and increased strain in postoperative voice. Patients
with postoperative nerve damage had a drastic decline in subjective voice quality
(VHI all subscales and total score), AVA parameter jitter, MPT and perceptual voice
quality. Subjective evaluation of swallowing revealed disturbances in all patients
regardless of the nerve damage.
We noticed remarkable differences in first week and first month visits between patients
with permanent and temporary palsy in VHI total score and physical domain, MPT and
perceptual breathiness and asthenia in voice. Regardless of the nerve injury, by the
end of the follow-up period all changes had become statistically insignificant with
the exception of perceptual evaluation of voice quality.
Conclusions
Patients with postoperative laryngeal nerve damage experience substantial deterioration
of both subjective and objective voice quality with more extensive impairment in patients
with permanent paralysis. Thyroid surgery causes subjective swallowing changes irrespective
of laryngeal nerve damage. In patients without laryngeal nerve damage, swallowing
function improves following thyroidectomy. Possible indicators for permanent paralysis
are delayed recovery in the values of MPT and jitter and persistent perceptual breathiness
and asthenia.
Key words
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Article info
Publication history
Published online: April 08, 2022
Accepted:
March 10,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
