2018 Section 6 - Laryngology, Voice Disorders, and Bronchoesophalogy

Surgery December 2016

Lee et al

Table I. Patient demographics and study groups All

Total thyroidectomy

Hemithyroidectomy

No. of patients Mean age, y (SD) Female:male ratio

62

37

25

47.7 (16.0)

46.3 (16.1)

49.6 (16.0)

53:9

32:5

21:4

Temporary RLN Palsy, N (%)

4 (6.5)

3 (8)

1 (4)

RLN , Recurrent laryngeal nerve; SD , standard deviation.

Table II. Voice quality before and after thyroid operation: palsy versus nonpalsy for the Voice Disorder Index (0 best, 40 worst) All patients N = 62 No palsy N = 58 Palsy N = 4 Difference P value Mean preoperative score (SE) 4.2 (0.8) 3.8 (0.6) 10.8 (7.3) 7.0 (2.9) .02 Mean postoperative score (SE) 9.4 (1.2) 8.1 (1.1) 28.0 (4.5) 19.9 (4.3) < .01 VDI change (SE) 5.2 (1.2) 4.3 (1.1) 17.3 (9.4) 12.9 (4.7) .01 P value < .01 < .01 .165 Table III. Voice quality before and after thyroid operation: palsy versus nonpalsy for the Dysphonia Severity Index (worst 5, best 5) All patients N = 62 No palsy N = 58 Palsy N = 4 Difference P value Mean preoperative score (SE) 3.9 (0.3) 4.1 (0.3) 1.8 (1.4) 2.2 (1.0) .03 Mean postoperative score (SE) 2.8 (0.3) 3.0 (0.2) 0.3 (1.0) 3.3 (0.9) < .01 DSI change (SE) 1.1 (0.2) 1.1 (0.3) 2.4 (0.6) 1.3 (1.0) .2 P value < .01 < .01 .042 SE , Standard error.

DSE , Dysphonia Severity Index; SE , standard error.

with a postoperative palsy also had a higher VDI score than the nonpalsy patients ( P = .02) before operation ( Table II ). The DSI scores (objective assessment) comparing preoperative and postoperative voice assessments showed a trend very similar to that of the VDI scores. The overall score deteriorated from 3.9 to 2.8 ( P < .01). Significant deterioration in DSI also was seen in both the palsy and nonpalsy subgroups ( P = .042 and P < .01 respectively; Table III ). As expected, patients with a postopera- tive palsy had worse DSI scores ( P < .01), but once again, they also had worse DSI scores before undergoing operation ( P = .03). Patients having either a total thyroidectomy or a hemithyroidectomy both showed significant dete- rioration in their VDI scores ( P < .01 and .02, respectively; Tables IV and V ). However, objectively, the DSI scores deterioration postoperatively was only seen in patients undergoing a total thyroidec- tomy ( P < .01), not those undergoing a hemithyr- oidectomy ( P = .1; Tables IV and V ). A small group of 13 patients attended the follow-up assessments, including 3 patients with a temporary unilateral RLN palsy ( Table VI ). Of

these, 6 patients had hemithyroidectomy and 7 had total thyroidectomy. The median follow-up was 8 months (range, 6–14 months). In this group of patients, the follow-up mean VDI was 4.2 ± 0.8, no different from their mean preoperative VDI of 7.1 ± 2.7 ( P = .26). Their follow-up mean DSI was 5.4 ± 0.9, even better their mean preoperative DSI of 3.5 ± 0.9 ( P = .01). Collectively, the RLN diameter increased by 0.58 ± 0.05 mm (1.82 ± 0.05 mm to 2.40 ± 0.05 mm; P < .01). Using Pearson correla- tion, it was demonstrated that the DSI scores of hemithyroidectomy patients correlated to the de- gree of RLN swelling observed intraoperatively. This correlation was not shown in total thyroidec- tomy patients or the VDI scores of hemithyroidec- tomy patients ( Table VII , Fig ). DISCUSSION The data in this study suggest that the quality of voice deteriorated after thyroid operation, both subjectively and objectively. In addition, this dete- rioration was more pronounced in total thyroidec- tomy patients than hemithyroidectomy patients.

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