Reply to: "Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study": Methodological issues on questionnaire validation

Abstract Background Voice alterations after thyroidectomy with mobile vocal folds are common. Ultrasonography has been used to assess the mobility of the vocal folds after thyroidectomy. Methods 54 patients underwent thyroidectomy. Indirect laryngoscopy, ultrasonography and GRBAS scoring were performed preoperatively,3 days, 2 and 6 months postoperatively. Results On the third postoperative day, the mobility of the vocal folds was preserved in 52 patients and paresis were recorded in 2 patients. All patients after total thyroidectomy noted the presence of voice alteration in the absence of the postoperative paresis of the vocal folds. On the third postoperative day, the voice was impaired by all criteria of the GRBAS scale, but mainly due to roughness (85%). Sixth month postoperatively 62% of the subjects considered the voice to be altered. Asthenia was observed in 39%. On the third postoperative day indirect laryngoscopy revealed the unchanged vocal folds, the symmetrical edema and the shortening of one of the vocal folds in 56%,42% and 1.9%. Six months postoperatively, the vocal folds returned to their original form. Ultrasonography was well correlated to the results of indirect laryngoscopy. Patients with edema of the vocal folds had a significantly higher mean GRBAS grade than patients without edema. The mean GRBAS score decreased from 3.36 to 0.90, 3 days and 6 months postoperatively. Conclusion Voice alteration after total thyroidectomy is always present. Postoperative edema represents a likely main cause of voice alteration and resolves within 6 months. Ultrasonography is recommended as alternative to indirect laryngoscopy in assessing of the vocal folds in thyroid surgery patients.

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Occurrence of Clinically Significant Hypocalcemia 6 to 12 Months After Total Thyroidectomy Could Be Overrated: Results of a Prospective Multicenter Study

International Surgery ◽

10.9738/intsurg-d-18-00024.1 ◽

2018 ◽

Vol 103 (7-8) ◽

pp. 344-350

Author(s):

Vitalijus Eismontas ◽

Algirdas Slepavicius ◽

Vinsas Janusonis ◽

Paulius Zeromskas ◽

Arvydas Martinkenas ◽

...

Keyword(s):

Total Thyroidectomy ◽

Multicenter Study ◽

Clinical Symptoms ◽

Clinical Value ◽

Prospective Multicenter Study ◽

Hydroxyvitamin D ◽

Hospital Patients ◽

Patient Groups ◽

25 Hydroxyvitamin D ◽

Clinically Significant

Objective: The aim of this study was to compare 2 groups of patients, normocalcemic and hypocalcemic, 6 to 12 months after total thyroidectomy and to determine the clinical value of the calcium levels on hospital discharge. Summary of background data: Thyroid surgeries are among the most common operations performed in the world. Hypocalcemia after total thyroidectomy is a common complication that is sometimes difficult to correct. Methods: From January 2015 through April 2017, 400 patients were included in this prospective multicenter study. All the patients underwent total thyroidectomy. By way of random of selection, 2 groups of patients were formed: 30 patients who had a normal level of calcium detected in the blood on discharge from the hospital after total thyroidectomy (normocalcemia group), and 30 patients who had a reduced level of calcium in the blood on discharge from the hospital (hypocalcemia group). In these groups of patients, various parameters were determined. Results: The comparison of patient groups with normocalcemia and hypocalcemia on discharge from the hospital and 6 to 12 months after surgery demonstrated that there were no statistically significant factors for postoperative hypocalcemia. Generally, there were no differences between the groups 6 to 12 months after surgery. Conclusions: Treatment with calcium and 25-hydroxyvitamin D preparations after surgery leads to disappearance of both biochemical and clinical expression of hypocalcemia in most cases. On discharge from the hospital, patients with more pronounced hypocalcemia should be administered calcium and calcitriol preparations, even in the absence of clinical symptoms.

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Validation of the Voice Handicap Index: 10 (VHI-10) to the Brazilian Portuguese

CoDAS ◽

10.1590/s2317-17822013000500013 ◽

2013 ◽

Vol 25 (5) ◽

pp. 482-485 ◽

Cited By ~ 20

Author(s):

Thiago Costa ◽

Gisele Oliveira ◽

Mara Behlau

Keyword(s):

Brazilian Portuguese ◽

Voice Handicap Index ◽

The Self ◽

Voice Rehabilitation ◽

Self Assessment ◽

Significant Difference ◽

Psychometric Measures ◽

Vocal Quality ◽

High Level ◽

The Voice

PURPOSE: To validate the Voice Handicap Index - 10 (VHI-10) into Brazilian Portuguese and to check its psychometric measures. METHODS: The validation was performed following the guidelines suggested by the Scientific Advisory Committee of the Medical Outcomes Trust. A hundred ten individuals participated, 60 with vocal complaint, 6 males and 54 females, with age ranging from 21 to 82 years; and 50 without vocal complaint, 6 males and 44 females, age ranging from 18 to 87 years. The procedures performed were a voice self-assessment and the VHI-10. For the self-assessment, the individuals evaluated their vocal quality by means of a five-point scale: excellent, very good, good, fair and poor. The VHI-10 was administered twice to 30 of the 60 individuals with vocal complaint to determine the test-retest reproducibility. For checking the sensitivity, the VHI-10 was administered to 21 patients that underwent voice rehabilitation. RESULTS: The validity was determined by comparing the total score with the self-assessment results. Individuals that classified their voice as poor had a total score of 28.2 (standard deviation=8). Internal consistence was determined with high values of coefficient (p<0.001). Results showed a high level of reproducibility (p=0.0114). Sensitivity was demonstrated with a significant difference between pre and post-rehabilitation results (p<0.005). CONCLUSION: The VHI-10 is an instrument validated into Brazilian Portuguese, with psychometric measures of validity, reliability and sensibility proven and can be applied to individuals with voice problems.

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Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study

BMC Surgery ◽

10.1186/s12893-018-0387-2 ◽

2018 ◽

Vol 18 (1) ◽

Cited By ~ 15

Author(s):

Vitalijus Eismontas ◽

Algirdas Slepavicius ◽

Vinsas Janusonis ◽

Paulius Zeromskas ◽

Virgilijus Beisa ◽

...

Keyword(s):

Total Thyroidectomy ◽

Multicenter Study ◽

Prospective Multicenter Study ◽

Postoperative Hypocalcemia

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Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study

Surgery ◽

10.1016/j.surg.2017.09.023 ◽

2018 ◽

Vol 163 (4) ◽

pp. 796-800 ◽

Cited By ~ 6

Author(s):

Frédéric Borel ◽

Niki Christou ◽

Olivier Marret ◽

Muriel Mathonnet ◽

Cécile Caillard ◽

...

Keyword(s):

Total Thyroidectomy ◽

Multicenter Study ◽

Voice Quality ◽

Prospective Multicenter Study ◽

Quality Outcomes

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Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma)

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18084300 ◽

2021 ◽

Vol 18 (8) ◽

pp. 4300

Author(s):

Zuzana Veldova ◽

Richard Holy ◽

Jan Rotnagl ◽

Temoore Younus ◽

Jiri Hlozek ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Total Thyroidectomy ◽

Voice Quality ◽

Laryngeal Nerve ◽

Voice Handicap Index ◽

Mean Values ◽

Group I ◽

The Mean ◽

Group Ii ◽

The Voice

Introduction: Total thyroidectomy (TT) is one of the most common surgical endocrine surgeries. Voice impairment after TT can occur not only in patients with recurrent laryngeal nerve (RLN) transient paralysis, but also in cases of normal vocal cord mobility. Aim: To compare voice limits using a speech range profile (SRP) in patients before and 14 days after TT and to investigate the influence of the early results of voice quality after TT on the personal lives of patients. We focused on the perception of voice change before and shortly after TT. Materials and methods: A retrospective study, in the period 2018–2020, included 65 patients aged 22–75 years. We compared two groups of patients: group I (n = 45) (without RLN paresis) and group II (n = 20) (with early transient postoperative RLN paresis). Patients underwent video flexible laryngocopy, SRP, and Voice Handicap Index-30 (VHI-30). Results: In group I, the mean values of Fmax (maximum frequency) and Imax (maximum intensity) decreased in women (both p = 0.001), and VHI-30 increased (p = 0.001). In group II after TT in women, the mean Fmax and Imax values decreased (p = 0.005 and p = 0.034), and the frequency range of the voice was reduced from 5 to 2 semitones. The dynamic range of the voice was reduced by 3.4 dB in women and 5.1 dB in men.VHI-30 increased (p = 0.001). Conclusion: The study documented a worsening of the mean values of SRP, VHI-30, and voice parameters of patients in group II. Voice disorders also occurred in group I without RLN paresis. Non-paretic causes can also contribute to voice damage after TT. SRP and VHI-30 are suitable tools for comparing voice status in two groups of patients, including those with dysphonia. Our data support the claim that the diagnosis of a thyroid cancer does not necessarily imply a higher postoperative risk of impaired voice quality for the patient.

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Patient Self-Assessment and Acoustic Voice Analysis in Screening of Postoperative Vocal Fold Paresis and Paralysis

Scandinavian Journal of Surgery ◽

10.1177/14574969211007036 ◽

2021 ◽

pp. 145749692110070

Author(s):

M. Heikkinen ◽

E. Penttilä ◽

M. Qvarnström ◽

K. Mäkinen ◽

H. Löppönen ◽

...

Keyword(s):

Vocal Fold ◽

Voice Handicap Index ◽

Index Score ◽

Parathyroid Surgery ◽

Voice Analysis ◽

Self Assessment ◽

Acoustic Voice Analysis ◽

Vocal Fold Paresis ◽

The Voice ◽

Patient Self Assessment

Background and Aims: The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program. Materials and Methods: This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis. Results: Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis. Conclusion: In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.

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