Analysis of Voice and Swallowing Symptoms after Thyroidectomy in Patients without Recurrent Laryngeal Nerve Injury in Early Postoperative Period

반회후두신경 손상을 동반하지 않은 갑상선 절제술 환자에서 수술 초기의 음성 및 연하 기능의 변화에 대한 분석

  • Kim, Heejin (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Keum, Bo-Ram (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Kim, Geun Hee (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Jeon, Seung Sik (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Kim, Hyejeen (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Kim, Sung Kyun (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Hong, Seok Jin (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Hong, Seok-Min (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Kim, Yong-Bok (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University) ;
  • Park, Il-Seok (Department of Otolaryngology-Head & Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University)
  • 김희진 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 금보람 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 김근희 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 전승식 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 김혜진 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 김성균 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 홍석진 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 홍석민 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 김용복 (한림대학교 의과대학 동탄성심병원 이비인후과학교실) ;
  • 박일석 (한림대학교 의과대학 동탄성심병원 이비인후과학교실)
  • Received : 2016.10.13
  • Accepted : 2016.10.28
  • Published : 2016.12.30

Abstract

Background and Objectives : After thyroidectomy, many patients experience problems report such things as reduced voice range and vocal fatigue, swallowing problems without superior and recurrent laryngeal nerve injury. The purpose of this study was to evaluate voice and swallowing problems before and after thyroid surgery without laryngeal nerve injury. Materials and Methods : Ninety-three patients who underwent thyroidectomy without laryngeal nerve injury and completed the follow-up evaluations were studied between June 2013 and December 2015. Each evaluation was performed preoperatively, as well as 1 week, 1 month postoperatively. Analysis was performed including voice handicap index (VHI), dysphagia handicap index (DHI), and acoustic voice analysis. Results : Patients show significant variation of parameters in the fundamental frequency (F), maximal phonation time (MPT), shimmer, jitter and soft phonation index (SPI) early after operation, and most of them showed recovery of parameters after 1month of operation. Perceptive complaint of voice and swallowing also showed significant decreased after operation (p<0.005). After 1month of operation, MPT, highest frequency and frequency ranges still showed significant decreased parameters. Comparing acoustic and perceptive parameters of total thyroidectomy and lobectomy, there was no significant changes between them except highest frequency (p=0.042). Conclusion : The results from both subjective and objective evaluations show voice and swallowing disturbance after thyroidectomy even in the absence of laryngeal nerve and provide patients information about the recovery process after surgery. Highest frequency parameter showed most significant changes after operation.

Keywords

References

  1. de Pedro Netto I, Fae A, Vartanian JG, Barros AP, Correia LM, Toledo RN, et al. Voice and vocal self-assessment after thyroidectomy. Head Neck 2006;28(12):1106-14. https://doi.org/10.1002/hed.20480
  2. Grover G, Sadler GP, Mihai R. Morbidity after thyroid surgery: patient perspective. Laryngoscope 2013;123(9):2319-23. https://doi.org/10.1002/lary.23850
  3. Scerrino G, Inviati A, Di Giovanni S, Paladino NC, Di Paola V, Lo Re G, et al. Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results. Otolaryngol Head Neck Surg 2013;148(6):926-32. https://doi.org/10.1177/0194599813482299
  4. Hong KH. Post-thyroidectomy syndrome. Korean J Otorhinolatyngol-Head Neck Surg 2014;57(5):297-303. https://doi.org/10.3342/kjorl-hns.2014.57.5.297
  5. Park KN, Mok JO, Chung CH, Lee SW. Does Postthyroidectomy Syndrome Really Exist Following Thyroidectomy? Prospective Comparative Analysis of Open vs. Endoscopic Thyroidectomy. Clin Exp Otorhinolaryngol 2015;8(1):76-80 https://doi.org/10.3342/ceo.2015.8.1.76
  6. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 1997;117(4):399-404. https://doi.org/10.1016/S0194-5998(97)70133-5
  7. 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(6):823-32. https://doi.org/10.1097/00000658-200212000-00015
  8. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 1997;117(4):399-404. https://doi.org/10.1016/S0194-5998(97)70133-5
  9. Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F. Post-thyroidectomy superior laryngeal nerve injury. Eur Arch Otorhinolaryngol 2001;258(9):451-4. https://doi.org/10.1007/s004050100382
  10. Sinagra DL, Montesinos MR, Tacchi VA, Moreno JC, Falco JE, Mezzadri NA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg 2004;199(4):556-60. https://doi.org/10.1016/j.jamcollsurg.2004.06.020
  11. Lang BH, Wong CK, Ma EP. A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy. Laryngoscope 2016;126(2):528-37. https://doi.org/10.1002/lary.25452
  12. Traunmuller H, Eriksson A. The frequency range of the voice fundamental in the speech of male and female adults. Institutionen for lingvistik, Stockolms universitrt, Stockholm, Sweden;1993
  13. Song CM, Yun BR, Ji YB, Sung ES, Kim KR, Tae K. Long-term voice outcomes after robotic thyroidectomy. World J Surg 2016;40(1):110-6. https://doi.org/10.1007/s00268-015-3264-5
  14. Randolph GW, Sritharan N, Song P, Franco R Jr, Kamani D, Woodson G. Thyroid-ectomy in the professional singer-neural monitored surgical outcomes. Thyroid 2015;25(6):665-71. https://doi.org/10.1089/thy.2014.0467
  15. Mauriello C, Marte G, Canfora A, Napolitano S, Pezzokka A, Gambardella C, et al. Bilateral benign multinodular goiter. What is the adequate surgical therapy? A review of literature. Int J Surg 2016;28(1):S7-12. https://doi.org/10.1016/j.ijsu.2015.12.041
  16. Arakawa-Suqueno L, Ferraz AR, Morandi J, Capobianco DM, Cernea CR, Sampaoi MA, et al. Videoendoscopic evaluation of swallowing after thyroidectomy: 7 and 60 days. Dysphagia 2015;30(5):496-505. https://doi.org/10.1007/s00455-015-9628-z
  17. Ryu JS, Lee JH, Kand JY, Kim MY, Shin DE, Shin DA. Evaluation of dysphagia after cervical surgery using laryngeal electromyography. Dysphagia 2012;27(3):318-24. https://doi.org/10.1007/s00455-011-9368-7
  18. Tae K, Kim KY, Yun BR, Ji YB, Park CW, Kim DS, et al. Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surg Endosc 2012;26(7):1871-7. https://doi.org/10.1007/s00464-011-2116-0