Total Versus Completion Thyroidectomy: A Multidimensional Evaluation of Long-Term Vocal Alterations

Abstract

Background: Total thyroidectomy (TT) and completion thyroidectomy (CT) are two common surgical operations that are frequently followed by vocal symptoms despite preservation of the recurrent laryngeal nerve (RLN) and of the external branch of superior laryngeal nerve (EBSLN). The aim of this study was to analyze vocal alterations through endoscopic findings, videolaryngostroboscopy (VLS), acoustic vocal parameters and impact on patients’ quality of life after surgery in the absence of laryngeal nerve injury. Methods: We enrolled 198 patients who underwent thyroidectomy by the same surgeon. One hundred twenty-six patients underwent TT (group TT) while 72 underwent CT (group CT). All patients underwent preoperative VLS and Voice Handicap Index (VHI) assessment and postoperative VHI, VLS and Acoustic Voice Analysis with Multidimensional Voice Program Analysis 12 to 18 months after surgery. Results: We observed a statistically significant higher rate of EBSLN injury in CT compared to TT. Even in the absence of RLN and EBSLN injury, patients who underwent TT and CT presented slightly worse acoustic vocal parameters and VHI scores compared to healthy controls. Interestingly, some acoustic vocal parameters and VHI scores were significantly worse in group CT compared to group TT. Conclusions: The higher rate of EBSLN injury in CT rather than in TT suggests a higher surgical risk in CT. The vocal parameters of loudness and self-perception of voice were significantly worse after CT, suggesting a larger trauma in patients’ vocal outcome in CT if compared to TT, although these alterations were not reported as psychologically limiting daily life of patients. Nevertheless, the existence of multiple factors contributing to vocal alterations after thyroidectomy highlight the importance of a routine comprehensive functional voice analysis before and after surgery.

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

“…The vocal degradation might therefore be overestimated allowing us to identify patients with an altered voice, whereas it was considered to be of good quality by the averages at VHI 10, GRBAS and DSI scores analyzed separately. Among the risk factors identified in our model, age was also described by Sahli et al [15], as well as thyroid reintervention [16]. Calcifications of laryngeal cartilage, alteration of the laryngeal lining, or atrophy of laryngeal muscles accompanying aging have all been suggestions advanced to explain that age is an independent risk factor for vocal impairment after thyroid surgery [17].…”

Voice Condition Following Short-Term Endotracheal Intubation in Head and Neck Surgery: Study Protocol for Clinical Trial

“…Voice disorders after thyroidectomy are present very often even in cases where there are no visible injuries to the laryngeal nerve, vocal cords or cricoarytenoid joint 6,7 . These disorders are associated with different factors; longer duration of surgery, larger volume of the operated thyroid gland, female gender and older age are associated with a higher frequency of hoarseness [21][22][23][24] . However, how much hoarseness after such operations is due solely to the influence of anesthesia (length of anesthesia, tube size, intubation technique), general condition of the patient (age, sex, comorbidity), and how much of the specifics of thyroid surgery (intense movement of the larynx, resection and stretching of the prelaryngeal musculature) is not known.…”

Advances in the assessment of cosmetic outcomes, sensory alteration in surgical areas, and health-related quality of life of endoscopic thyroidectomy

“…Patients vocalize a certain vowel, which is recorded by a microphone. The primary parameters are F0 (fundamental frequency), Jitter (the relative variability of the pitch in the short-term, %), PPQ (pitch perturbation quotient), Shim (the relative variability of the peak-to-peak amplitude in the short-term, %), and the APQ (amplitude perturbation quotient), NHR (noise-to-harmonic ratio), MPT (maximum phonation time) [ 11 , 53 , 54 , 56 , 57 ].…”