Improving Voice Outcomes After Thyroid Surgery

Publication Date: June 3, 2013

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

...e and branches of RLN and SLNFrom Randolph...

Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove

...tionship of RLN and SLN to thyroid lob...

Variations of nonrecurrent recurrent laryngeal nerve

...of nonrecurrent recurrent laryngeal ne...

Diagnosis

...agnosi...

...tion Statement...

...eoperative Manageme...

...VOICE ASSESSMENT:The surgeon should docum...

...LARYNGEAL ASSESSMENT OF THE IMPAIRED VOICE:The s...

...IVE LARYNGEAL ASSESSMENT OF THE NONI...

...ATIENT EDUCATION ON VOICE OUTCOMES:The clini...

...WITH ANESTHESIOLOGIST:The surgeon shoul...


.... Preoperative Voice Assessment Chart...


...e 2. Discussion Points for the Surgeon/Patient E...


.... Preoperative Factors that May Be Associated with...


Treatment

...atment...

...ion Statements...

IDENTIFYING RLN:The surgeon should i...

...SLN:The surgeon should take steps to preser...

...TIVE EMG MONITORING:The surgeon or a designee may...

...E CORTICOSTEROIDS:No recommendation can be made...

...VE VOICE ASSESSMENT:The surgeon should document w...

...STOPERATIVE LARYNGEAL EXAMINATION:Cl...

...LOGY REFERRAL:The clinician should refer a...

...OICE REHABILITATION:Clinicians should counsel p...


Table 4. Causes of Thyroidectomy-related Dysphonia

...4. Causes of Thyroidectomy-related...

Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy

.... Discussion Points for a Patient Who Has...