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
...and branches of RLN and SLNFrom Randol...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...ship of RLN and SLN to thyroid lobe and tr...
Variations of nonrecurrent recurrent laryngeal nerve
...ons of nonrecurrent recurrent laryngea...
Diagnosis
Diagnosi...
...tion Statements...
...reoperative Management
...VOICE ASSESSMENT:The surgeon should...
...LARYNGEAL ASSESSMENT OF THE IMPAIRED VOICE:The...
...RATIVE LARYNGEAL ASSESSMENT OF THE NONI...
...TION ON VOICE OUTCOMES:The clinicia...
...WITH ANESTHESIOLOGIST:The surgeon...
...reoperative Voice Assessment ChartH...
...iscussion Points for the Surgeon/Patient...
...reoperative Factors that May Be Associate...
Treatment
...reatment...
...ey Action Statements...
...TIFYING RLN:The surgeon should identify the RLN(s...
...CTION OF SLN:The surgeon should ta...
...VE EMG MONITORING:The surgeon or a designee ma...
...OPERATIVE CORTICOSTEROIDS:No recomme...
POSTOPERATIVE VOICE ASSESSMENT:The surgeon sh...
...LARYNGEAL EXAMINATION:Clinicians sho...
...OLOGY REFERRAL:The clinician should re...
...EHABILITATION:Clinicians should counsel patie...
Table 4. Causes of Thyroidectomy-related Dysphonia
.... Causes of Thyroidectomy-related Dy...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...ble 5. Discussion Points for a Patient Who Ha...