Voice Outcomes after Total Thyroidectomy, Partial Thyroidectomy, or Non-Neck Surgery Using a Prospective Multifactorial Assessment

• Published in: Journal of the American College of Surgeons Vol. 219; no. 1; pp. 152 - 163
• Main Authors: Vicente, Diego A., MD, Solomon, Nancy P., PhD, CCC-SLP, Avital, Itzhak, MD, FACS, Henry, Leonard R., MD, FACS, Howard, Robin S., MA, Helou, Leah B., MA, CCC-SLP, Coppit, George L., MD, Shriver, Craig D., MD, FACS, Buckenmaier, Chester C., MD, Libutti, Steven K., MD, FACS, Shaha, Ashok R., MD, FACS, Stojadinovic, Alexander, MD, FACS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2014
• Subjects: Adult; Algorithms; Bariatric Surgery; Cholecystectomy, Laparoscopic; Decision Support Techniques; Dysphonia - diagnosis; Dysphonia - etiology; Dysphonia - therapy; Female; Follow-Up Studies; Herniorrhaphy; Humans; Laryngoscopy - methods; Male; Middle Aged; Odds Ratio; Outcome Assessment (Health Care); Parathyroidectomy; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Postoperative Complications - therapy; Prospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Surgery; Thyroidectomy - methods; NN; partial thyroidectomy; TT; PT; total thyroidectomy; negative voice outcomes; objective negative voice outcomes; subjective negative voice outcomes; non-neck surgery; CAPE-V; Dysphonia Severity Index; NegVO; Voice Outcomes Appraisal, Longitudinal; RLN; recurrent laryngeal nerve; VHI; Videolaryngostroboscopy; DSI; receiver operating characteristic; VLS; Voice Handicap Index; Consensus Auditory-Perceptual Evaluation of Voice; ROC; NegVOsubj; VOCAL; NegVOobj
• ISSN: 1072-7515; 1879-1190
• DOI: 10.1016/j.jamcollsurg.2014.03.019

Background Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool. Study Design Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups. Results Negative voice outcomes occurred in 46% (95% CI, 34–59%) and 14% (95% CI, 6–30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO. Conclusions This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.