Voice changes after thyroidectomy: an experience with 364 cases of thyroid surgery

Authors

  • Arvind K. Prabhat Department of General Surgery, DVVPF’S Medical College and Hospital, Ahmednagar, Maharashtra, India
  • Niranjan Dash Department of General Surgery, DVVPF’S Medical College and Hospital, Ahmednagar, Maharashtra, India
  • J. M. Gadekar Department of General Surgery, DVVPF’S Medical College and Hospital, Ahmednagar, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-2902.isj20180365

Keywords:

Completion thyroidectomy, Recurrent laryngeal nerve (RLN) palsy, Sub-total thyroidectomy, Total thyroidectomy

Abstract

Background: To study voice changes and to evaluate the impact of thyroidectomy and effects of factors such as patient age, sex, operation-type, surgeons-experience, laryngeal nerve injury and orotracheal intubation on voice of patients undergoing thyroidectomy.

Methods: Author prospectively analyzed 364 cases of multinodular goiter (MNG) and neoplastic thyroid disorders, undergoing sub-total/total-thyroidectomy and completion-thyroidectomy in the department of surgery, during the study period of June 2016 to December 2016.

Results: The study comprised of 364 patients, with 298 females and 66 males. Voice changes were seen in 216(59.34%) patients. Transient voice changes were seen in 212(98.15%) patients and permanent in 4(1.85%) patents. Out of 216 patents, age group ≥65 years were 128(59.25%) and age group <65 years were 88(40.75%) patients(p:0.012324). Out of 216 patients in which voice changes were seen,165(76.39%) patients were females and 51(23.61%) patients were males(p:0.001046). Voice changes were seen in 190(88%) patients in which sub-total/total-thyroidectomies were performed and in 26(12%) patients completion-thyroidectomies were performed. Voice changes were statistically significant in which completion-thyroidectomies were performed(p:0.002102). Voice changes were seen in 205(68.56%) cases and 11(16.92%) cases which were performed by post-graduate-trainee and experienced-surgeon respectively. Voice changes were seen in 122(67.77%) cases in which orotracheal intubation was performed and in 94(51.65%) cases cervical-epidural anaesthesia was given (p:0.00281). RLN palsy was seen in 2(0.60%) cases in which sub-total/total-thyroidectomy were performed and 2(6.25%) cases in which completion-thyroidectomy was performed (p:0.003426).

Conclusions: Voice changes is common after thyroid surgery but usually transient and sometimes, permanent. So, patients must be informed about the risk of voice-impairment after thyroid surgery. Present study is novel as it investigates not only laryngeal neve injury but also highlights patient age, sex, types of operation, surgeons experience and laryngeal complications during orotracheal intubation.

References

Page C, Zaafar R, Biet A, Strunski V. Subjective voice assessment after thyroid surgery: a prospective study of 395 patients. Indian J Med Sci. 2007;61(8):448-54.

Hazem MZ, Naif AA, Ahmed AS. Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J. 2011;26:34-8.

Kelly J, Mahalingam S. Surgical treatment of head and neck cancers in the ancient world. J Laryngol Otol. 2015;25:1-5.

Khan JS, Malik K, Khawaja ZH. Recurrent laryngeal nerve in thyroid surgery: is routine identification necessary? J RMC. 2008;12:16-8.

Stevens K, Stojadinovic A, Helou LB. The impact of recurrent laryngeal neuromonitoring on multi-dimensional voice outcomes following thyroid surgery. J Surg Oncol. 2012;105:4.

Chiang FY, Lee KW, Chen HC. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg. 2010;34:223.

Sari S, Erbil Y, Sumer A. Evaluation of recurrent laryngeal nerve monitoring in thyroid surgery. Int J Surg. 2010;8:474.

A E kark, M W Kissin, R Auerbach, M Meikle. Voice changes after thyroidectomy: role of the external laryngeal nerve. Br Med J. 1984;289(6456):1412-5.

Echternach M, Maurer C, Mencke T, Schilling M, Verse T, Richter B. Laryngeal Complications After Thyroidectomy, Is It Always the Surgeon? Arch Surg. 2009;144(2):149-53.

Akyildiz S, Ogut F, Akyildiz M, Engin EZ. A Multivariate Analysis of Objective Voice Changes After Thyroidectomy Without Laryngeal Nerve Injury. Arch Otolaryngol Head Neck Surg. 2008;134(6):596-602.

Mupparapu M, Vuppalapati A. Ossification of Laryngeal Cartilages On Lateral Cephalometric Radiographs. Angle Orthod. 2005;75(2):196-201.

Weymuller EA. Laryngeal injury from prolonged endotracheal intubation. Laryngoscop. 1988;98(8):1-15.

Thomusch O, Machens A, Sekulla C. Multivariate analysis of risk factors for post-operative complications in benign goiter surgery; Prospective multi-center study in Germany. World J Surg. 2000;24(11):1335-41.

Sosa JA, Bowman HM, Tielsch JM, Powe NR, Gordon TA, Udelsman R. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg. 1998;228(3):320-30.

Haugen BR, Alexander EK, Bible KC. American thyroid association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2015.

Proschel U, Eysholdt U. Short term changes in the larynx and voice after intubation in German. Laryngorhinootologie. 1993;72(2):93-7.

Peppard SB, Dickens JH. Laryngeal injury following short term intubation. Ann Otol Rhinol Laryngol. 1983;92(4):327-30.

Friedrich T, Hansch U, Eichfeld U, Steinert M, Staemmler A, Schonfelder M. Recurrent laryngeal nerve paralysis as intubation injury [in German] ? Chirug. 2000;71(5):539-44.

Benjamin B. Laryngeal trauma from intubation: endoscopic evaluation and classification. In: Cummings CW, Fredrickson JM, Haker LA, Krause CJ, Richardson MA, Schuller DE eds. Otolaryngology Head and Neck Surgery. St Louis, MO: Mosby; 1998:2013-2035.

Mencke T, Echternach M, Kleinschmidt S. Laryngeal morbidity and quality of tracheal intubation: a randomized controlled trial. Anaesthesiology. 2003;98(5):1049-56.

Mencke T, Knoll H, Schreiber JU. Rocuronium is not associated with more vocal cord injuries than succinylcholine after rapid sequence induction: a randomized, prospective,controlled trial. Anesth Analg. 2006;102(3):943-9.

Mencke T, Echternach M, Plinkert PK. Does the timing of trachel intubation based on neuromuscular monitoring decrease laryngeal injury? a randomized, prospective, controlled trial. Anesth Analg. 2006;102(1):306-12.

Downloads

Published

2018-01-25

Issue

Section

Original Research Articles