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

...hes of RLN and SLNFrom Randolph GW,...

Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove

...ionship of RLN and SLN to thyroid lo...

Variations of nonrecurrent recurrent laryngeal nerve

...of nonrecurrent recurrent laryngeal ner...

Diagnosis

...gnosis

...ion Statements

...ative Management...

...VOICE ASSESSMENT:The surgeon should d...

...ERATIVE LARYNGEAL ASSESSMENT OF THE IMPAIRE...

...PERATIVE LARYNGEAL ASSESSMENT OF THE...

...IENT EDUCATION ON VOICE OUTCOMES:The clin...

...MMUNICATION WITH ANESTHESIOLOGIST:The surgeon...


...rative Voice Assessment ChartHaving trou...


...ssion Points for the Surgeon/Patient...


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


Treatment

Treatm...

...tion Statement...

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

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

...EMG MONITORING:The surgeon or a desig...

...ORTICOSTEROIDS:No recommendation can be ma...

...RATIVE VOICE ASSESSMENT:The surgeon...

...IVE LARYNGEAL EXAMINATION:Clinicians should ex...

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

...ITATION:Clinicians should counsel patients...


Table 4. Causes of Thyroidectomy-related Dysphonia

Table 4. Causes of Thyroidectomy-related Dysphon...

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

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