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
...ches of RLN and SLN From Randolph GW, ed. S...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...p of RLN and SLN to thyroid lobe and trach...
Variations of nonrecurrent recurrent laryngeal nerve
...f nonrecurrent recurrent laryngeal nerve From Ste...
Diagnosis
...Diagnosis...
...Key Action S...
...Preoper...
...ICE ASSESSMENT:The surgeon should document...
...TIVE LARYNGEAL ASSESSMENT OF THE IMPAIRED VO...
...LARYNGEAL ASSESSMENT OF THE NONIMPAIRED VOICE:O...
...ON ON VOICE OUTCOMES:The clinician should educate...
...ON WITH ANESTHESIOLOGIST:The surgeon s...
...erative Voice Assessment Chart...
.... Discussion Points for the Surgeon/Patient E...
Table 3. Preoperative Factors that May Be Associa...
Treatment
...Treat...
...Key Act...
...N:The surgeon should identify the RLN(...
...ON OF SLN:The surgeon should take steps to preserv...
...TIVE EMG MONITORING:The surgeon or a d...
...PERATIVE CORTICOSTEROIDS:No recommendation can...
...OICE ASSESSMENT:The surgeon should document whet...
...ARYNGEAL EXAMINATION:Clinicians should exami...
...LARYNGOLOGY REFERRAL:The clinician should refer...
...ILITATION:Clinicians should counsel pa...
Table 4. Causes of Thyroidectomy-related Dysphonia
...4. Causes of Thyroidectomy-related Dysphonia...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...Discussion Points for a Patient Wh...