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
...urse and branches of RLN and SLNFrom Randolph G...
Relationship of RLN and SLN to thyroid lobe and tracheoesphageal groove
...nship of RLN and SLN to thyroid lobe and tr...
Variations of nonrecurrent recurrent laryngeal nerve
...of nonrecurrent recurrent laryngeal...
Diagnosis
...iagnosis...
...Action Stateme...
...ative Management...
...CE ASSESSMENT:The surgeon should document asse...
...YNGEAL ASSESSMENT OF THE IMPAIRED VOICE:The...
...VE LARYNGEAL ASSESSMENT OF THE NONI...
...TION ON VOICE OUTCOMES:The clinician should edu...
...WITH ANESTHESIOLOGIST:The surgeon should info...
...ble 1. Preoperative Voice Assessment Chart...
...2. Discussion Points for the Surgeon/Pat...
...3. Preoperative Factors that May Be Assoc...
Treatment
...atment...
...Action Statement...
...ENTIFYING RLN:The surgeon should identify th...
...SLN:The surgeon should take steps to preserv...
...ATIVE EMG MONITORING:The surgeon or a des...
...E CORTICOSTEROIDS:No recommendation can b...
...VE VOICE ASSESSMENT:The surgeon should document w...
...ARYNGEAL EXAMINATION:Clinicians should exam...
OTOLARYNGOLOGY REFERRAL:The clinician should re...
...HABILITATION:Clinicians should counsel p...
Table 4. Causes of Thyroidectomy-related Dysphonia
Table 4. Causes of Thyroidectomy-related Dyspho...
Table 5. Discussion Points for a Patient Who Has Voice Changes After Thyroidectomy
...le 5. Discussion Points for a Patient Who Has Voi...