Aerodynamic Features and Voice Therapy Interventions of Functional Voice Disorder after Thyroidectomy

갑상선 절제 술 후 기능적 음성장애의 공기역학적 특징과 음성치료 중재

  • Lee, Chang-Yoon (Department of Otorhinolaryngology, Dongnam Institute Of Radiological & Medical Sciences) ;
  • An, Soo-Youn (Department of Otorhinolaryngology, Dongnam Institute Of Radiological & Medical Sciences) ;
  • Chang, Hyun (Department of Otorhinolaryngology, Dongnam Institute Of Radiological & Medical Sciences) ;
  • Jeong, Hee Seok (Pusan National University Yangsan Hospital) ;
  • Son, Hee Young (Department of Otorhinolaryngology, Dongnam Institute Of Radiological & Medical Sciences)
  • 이창윤 (동남권원자력의학원 이비인후과) ;
  • 안수연 (동남권원자력의학원 이비인후과) ;
  • 장현 (동남권원자력의학원 이비인후과) ;
  • 정희석 (양산부산대학교병원) ;
  • 손희영 (동남권원자력의학원 이비인후과)
  • Received : 2015.05.19
  • Accepted : 2015.05.25
  • Published : 2015.06.01

Abstract

Background and Objectives:The objective of this study was to investigate the features of post-thyroidectomy subjective voice disorder by Voice Handicap Index (VHI) and Voice Symptom Scale (VOISS) through aerodynamic analysis and to investigate the appropriate voice therapy intervention. Materials and Methods:Twenty post-thyroidectomy patients who had no recurrent laryngeal nerve paralysis through laryngeal stroboscopy were enrolled for this study. Acoustic and aerodynamic evaluations were performed before operation, 2 weeks and 3 months after operation. Subjective voice evaluation was performed by VHI and VOISS. Aerodynamic evaluation was compared and analysed by maximum phonation time(MPT), phonation threshold pressure(PTP), mean air flow rate(MFR), etc. Subjective voice evaluation was surveyed through VHI and VOISS. To evaluate patients' symptoms related to functional voice disorder, scores on physical domain in VHI and VOISS were selected to be compared for each session. Results: The 10 out of 20 participants who complained of voice symptoms had no significant difference with pre-operation in acoustic evaluation, but all showed higher scores on 2 weeks and 3 months after operation compared to pre-operation, in VHI-physical domain and selected questionnaires in VOISS. They reduced MPT and increased PTP value simultaneously. Laryngeal massage and breathing training were simultaneously treated to them, 5 participants resulting in improvement in MPT and PTP compared to pre-treatment. Conclusion:Patients who complained voice change with no organic damage after thyroidectomy were all shown to have reduced MPT and increased PTP in some by aerodynamic evaluations. Reduced MPT may imply some problem in air flow beneath glottis. Increased PTP suggests much more effort in vocalization mechanism than pre-operation. Comparing aerodynamic evaluations in post-thyroidectomy may provide information on behavioral interventions. Additionally, study on laryngeal massage and breathing training simultaneously treated to patients with such voice disorder is needed to be conducted with larger number of participants.

Keywords

References

  1. Choi JS, Jeong JI, Jang MS, Son YI. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Korean Logo Phon 2010;21(1):37-41.
  2. Lombardi CP, Raffaelli M, Carmela DC, D'alatri L, Maccora D, Marchese MR, et al. Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. J Surg 2009;9(10):1174-81.
  3. Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B, et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 2002;236:823-32. https://doi.org/10.1097/00000658-200212000-00015
  4. Solomon NP, Helou LB, Makashay MJ, Stojadinovic A. Aerodynamic evaluation of the post-thyroidectomy voice. J Voice 2011;26(4):454-61.
  5. Finck C. Laryngeal dysfunction after thyroid surgery. Acta Chir Belg 2006;106:378-87. https://doi.org/10.1080/00015458.2006.11679911
  6. Bielamowicz S, Stager SV. Diagnosis of unilateral recurrent laryngeal nerve paralysis: La-ryngeal electromyography subjective rating scales, acoustic and aerodynamic measures. Laryngoscope 2006;116:359-64. https://doi.org/10.1097/01.MLG.0000199743.99527.9F
  7. Hartl DA, Hans S, Vaissiere J, Brasnu DA. Objective acoustic and aerodynamic measures of breathiness in paralytic dysphonia. A Eur Arch Otorhinolaryngol 2003;260:175-82. https://doi.org/10.1007/s00405-002-0542-2
  8. Stojadinovic A, Henry LR, Howard RS, Gurevich-Uvena J, Makashay M, Coppit GL, et al. Prospective trial of voice outcome after thyroidectomy: evaluation of patients-reported voice assessments in identifying post-thyroidectomy dysphonia. Surgery 2008;142:732-42.
  9. Soyln L, Ozbas S, Uslu HY, Kocak S. The evaluation of the causes of subjective voice di-sturbances after thyroid surgery. Am J Surg 2007;194:317-22. https://doi.org/10.1016/j.amjsurg.2006.10.009
  10. Kwon TK, Lim YS. Aerodynamic analysis of phonation. J Korean Logo Phon 2008;19(2):85-8.
  11. Plexico LW, Sandage MJ, Faver KY. Assessment of phonation threshold pressure: A crit-ical review and clinical implications. American J of Speech-Language Pathology 2011;20:348-66. https://doi.org/10.1044/1058-0360(2011/10-0066)
  12. Solomon NP, Dimattia MS. Effects of a vocally fatiguing task and systemic hydration on phonation threshold pressure. J Voice 2000;14:341-62. https://doi.org/10.1016/S0892-1997(00)80080-6
  13. Mibrath RL, Solomon NP. Do vocal warm-up exercise alleviate vocal fatigue? J Speech Lang Hear Res 2003;46:422-36. https://doi.org/10.1044/1092-4388(2003/035)
  14. Chang A, Karnell MP. Perceived phonatory effort and phonation threshold pressure across a prolonged voice loading task: a study of vocal fatigue. J Voice 2004;18:454-66. https://doi.org/10.1016/j.jvoice.2004.01.004
  15. Kwon SB, Wang SG. Yang BG. Jeon GR. Effects of Abdominal Respiration and Self Voice Feedback Therapy on the voice improvement of patients with vocal nodules. Speech Science 2006;13(3):133-53.
  16. Lee SW. Abdominal breathing teaching techniques. J Voice 2003;21:201-4.