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

Course and branches of RLN and SLNFrom Randolph G...

Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove

...hip of RLN and SLN to thyroid lobe and t...

Variations of nonrecurrent recurrent laryngeal nerve

...nonrecurrent recurrent laryngeal nerveFrom S...

Diagnosis

...iagnos...

Key Action State...

...reoperative Managem...

...ELINE VOICE ASSESSMENT:The surgeon sh...

...LARYNGEAL ASSESSMENT OF THE IMPAIRED VOI...

...ARYNGEAL ASSESSMENT OF THE NONIMPAIRED VOICE:O...

...ATIENT EDUCATION ON VOICE OUTCOMES:T...

...MUNICATION WITH ANESTHESIOLOGIST:The surgeon...


...operative Voice Assessment ChartHavi...


...2. Discussion Points for the Surgeon/Patien...


...3. Preoperative Factors that May Be Associated...


Treatment

...atment...

...ction Statements...

...NG RLN:The surgeon should identify the...

...N:The surgeon should take steps to pr...

...OPERATIVE EMG MONITORING:The surgeon or...

...ATIVE CORTICOSTEROIDS:No recommendation can be mad...

...VE VOICE ASSESSMENT:The surgeon shou...

...ATIVE LARYNGEAL EXAMINATION:Clinici...

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

...BILITATION:Clinicians should counsel patie...


Table 4. Causes of Thyroidectomy-related Dysphonia

...es of Thyroidectomy-related DysphoniaHaving troub...

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

...sion Points for a Patient Who Has Voice C...