Improving Voice Outcomes After Thyroid Surgery
Key Points
Key Points
- Voice disturbance may be identified at least temporarily in up to 80% of patients after thyroid surgery.
- About 1 in 10 patients experience temporary laryngeal nerve injury after surgery, with longer lasting voice problems in ≤1 in 25.
- The most common site of neural injury is the distal recurrent laryngeal nerve (RLN), which can be nonrecurrent in 0.5%-0.7% of cases (See figures below).
- The other nerves of major interest, and frequently less directly addressed during thyroid surgery, are the bilateral superior laryngeal nerves (SLN), injury to which can impair the ability to change pitch and reduce voice projection.
- Another less common surgical cause for post-thyroidectomy voice change may be cervical strap muscle injury.
- Nonsurgical causes may include laryngeal irritation, edema, or injury from airway management.
Course and branches of RLN and SLN
...nches of RLN and SLNFrom Randolph GW, e...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...ionship of RLN and SLN to thyroid lobe an...
Variations of nonrecurrent recurrent laryngeal nerve
...ions of nonrecurrent recurrent lar...
Diagnosis
...Diagnosis...
...Key Acti...
...Preoperati...
...LINE VOICE ASSESSMENT:The surgeon should docume...
...LARYNGEAL ASSESSMENT OF THE IMPAIRED...
...OPERATIVE LARYNGEAL ASSESSMENT OF THE NONIMP...
...TION ON VOICE OUTCOMES:The clinician should...
...CATION WITH ANESTHESIOLOGIST:The surgeon...
...1. Preoperative Voice Assessment Cha...
...le 2. Discussion Points for the Surgeo...
...operative Factors that May Be Associated with Extr...
Treatment
...Treatm...
...Key Action Statement...
...LN:The surgeon should identify the RLN(s...
...CTION OF SLN:The surgeon should take steps to pre...
...ERATIVE EMG MONITORING:The surgeon or...
...CORTICOSTEROIDS:No recommendation can be mad...
...VE VOICE ASSESSMENT:The surgeon should docume...
...OPERATIVE LARYNGEAL EXAMINATION:Cli...
...REFERRAL:The clinician should refer a...
...REHABILITATION:Clinicians should counsel pat...
Table 4. Causes of Thyroidectomy-related Dysphonia
...of Thyroidectomy-related DysphoniaHaving troubl...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...ion Points for a Patient Who Has Voic...