Is Vocal Cord Assessment before Total Thyroidectomy Required for All Patients?

2019 ◽  
Vol 85 (11) ◽  
pp. 1265-1268
Author(s):  
Birkan Birben ◽  
Sabri Özden ◽  
Sadettin Er ◽  
Bariş Saylam
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Univariate Analysis ◽  
Neck Surgery ◽  
Indirect Laryngoscopy ◽  
Surgical History ◽  
History Of ◽  
Independent Variable ◽  
The Mean

We investigated whether laryngoscopy should be performed before total thyroidectomy on all patients without a history of neck surgery. A total of 2523 patients who underwent total thyroidectomy between January 1, 2013, and March 18, 2018, were retrospectively examined. Pre-operative vocal cord examination was performed on 2070 of these patients by the otorhinolaryngology department using indirect laryngoscopy. Patients with a history of neck or thyroid surgery were not included in the study. The patients were evaluated in terms of age, gender, symptom (hoarseness/dyspnea), comorbidity, surgical history, biopsy, nodule diameter, pathological diagnosis, and tracheal deviation. Preoperative vocal cord paralysis was detected in 0.8 per cent of the patients (17/2070). Four patients (23.5%) were male and 13 patients (76.5%) were female. The mean age was 62 (range, 25–82) years. Seven of the 17 patients (41%) were symptomatic, with complaints of dyspnea in five and hoarseness in two. The univariate analysis revealed that a nodule diameter >30 mm and the presence of dyspnea were associated with vocal cord damage. Furthermore, the multivariate analysis showed that dyspnea alone was an independent variable ( P = 0.011). It is recommended that preoperative vocal cord evaluation should be performed only in patients with severe symptoms, such as dyspnea.

Voice disorders after total thyroidectomy: Prospective patient self-assessment in comparison with traditional and alternative methods of examining the vocal folds

2020 ◽  
Author(s):  
Alexander Shulutko ◽  
Vasiliy Semikov ◽  
Andrey Moiseev ◽  
Elkhan Osmanov ◽  
Yulia Boblak ◽  
...  
Keyword(s):  
Total Thyroidectomy ◽  
Vocal Folds ◽  
Indirect Laryngoscopy ◽  
Alternative Methods ◽  
Original Form ◽  
Self Assessment ◽  
The Third ◽  
The Mean ◽  
The Voice ◽  
Patient Self Assessment

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.

S183 – Intracordal Fat Assessment after Injection Laryngoplasty

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P137-P137
Author(s):  
Tuan-Jen Fang ◽  
Chao-Jan Wang ◽  
Hsueh-Yu Li
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Upper Airway ◽  
Fat Injection ◽  
Long Term Outcomes ◽  
Autologous Fat ◽  
The Mean ◽  
Fat Volume ◽  
Unilateral Vocal Cord Paralysis

Objectives Autologous fat injection for unilateral vocal cord paralysis is a popular procedure for immediate symptoms control, but uneven long-term outcomes were reported. Most authors believed that the continual resorption of injected fat was the cause of voice degradation. A long-term residual fat volume was evaluated. Methods We retrospectively reviewed the patients following autologous fat injection for symptomatic unilateral vocal cord paralysis from 2002 Aug to 2006 July. The patients accepted head and neck computed tomogragphy (CT) evaluation following surgery were included. A three-dimensional reconstruction of the images of larynx and upper airway was performed on the work station (Vitrea® 2, version 3.9). The volume of intracordal fat was then calculated. Results 5 males and 15 females of the mean age 49 were enrolled. The mean duration from lipoinjection surgery to the CT study is 23.0 months (12–50 months). The injection fat was found in all study cases. The estimated fat volume ranged from 0.01 to 0.75 ml with a mean 0.33 ml. Compare with the injected fat volume, a mean 27.5% fat survived. The correlation between residual fat volume rate and duration of follow-up is not significant. Conclusions The intracordal fat volume didn't decline from time. Long-term intracordal injected fat diminished but survived in all cases. The degradation may be caused by absorption or immediate extrusion from injection wound. An over-correction and prevention of extrusion postoperatively would improve the long-term outcomes.

Bilateral Vocal Cord Paralysis with Shy-Drager Syndrome

1993 ◽  
Vol 109 (5) ◽  
pp. 911-914 ◽  
Author(s):  
Rohit Bawa ◽  
Hassan H. Ramadan ◽  
Stephen J. Wetmore
Keyword(s):  
Orthostatic Hypotension ◽  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
English Literature ◽  
System Failure ◽  
Bilateral Vocal Cord Paralysis ◽  
Vocal Cord Paresis ◽  
Median Position ◽  
History Of ◽  
Emergency Tracheotomy

Shy-Drager syndrome consists of progressive autonomic nervous system failure with Parkinson's disease-like symptoms and orthostatic hypotension. It can also result in airway compromise from bilateral vocal cord paralysis. Fewer than 30 cases of severe bilateral vocal cord paresis or paralysis associated with the Shy-Drager syndrome have been reported in the English literature. We present a case of a 72-year-old man who had a 2-year history of orthostatic hypotension, neurogenic bladder, impotence, anhydrosis, and extremity weakness and paresthesias. Hoarseness and dyspnea with stridor developed as a result of bilateral vocal cord paralysis in the median position and required an emergency tracheotomy. This combination of symptoms resulted in the diagnosis of Shy-Drager syndrome. We present the case along with literature review of bilateral vocal cord paralysis with the Shy-Drager syndrome.

Management of Bilateral Benign Paroxysmal Positional Vertigo

2005 ◽  
Vol 133 (5) ◽  
pp. 769-773 ◽  
Author(s):  
Daniel M. Kaplan ◽  
Michel Nash ◽  
Alexander Niv ◽  
Mordechai Kraus
Keyword(s):  
American Academy ◽  
Benign Paroxysmal Positional Vertigo ◽  
Neck Surgery ◽  
Positive History ◽  
Positional Vertigo ◽  
History Of ◽  
The Mean ◽  
Symptomatic Side ◽  
Paroxysmal Positional Vertigo

Objective To describe a series of patients with bilateral benign paroxysmal positional vertigo (BiBPPV), with respect to demographics, management, and outcome. Methods All patients who were identified and treated for BiBPPV in a previous 36-month period with a minimal follow-up period of 6 months were included. Patients were treated with Epley's maneuver (EM) on the side that was more symptomatic and that had a greater velocity and amplitude of tortional nystagmus. Patients were re-treated according to symptoms and findings on follow-up visits. Results Ten patients were identified with BiBPPV. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 54 years. There was a positive history of recent head trauma in 4 of the patients. All patients recovered after performing a mean of 2.6 EMs during a 3-month period. One patient experienced unilateral recurrence and was re-treated successfully. Conclusion BiBPPV has typical characteristics and can be managed successfully with EM, performed on the more symptomatic side, followed by repeated treatments as needed. Ebm Rating: C © 2005 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. All rights reserved.

Injection and Removal of Teflon for Unilateral Vocal Cord Paralysis

1992 ◽  
Vol 101 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Herbert H. Dedo
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Thyroid Cartilage ◽  
Indirect Laryngoscopy ◽  
Air Leak ◽  
Vocal Cords ◽  
Laryngeal Framework Surgery ◽  
The Voice ◽  
Major Defect ◽  
Unilateral Vocal Cord Paralysis

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.

scholarly journals Unilateral Vocal Cord Paralysis Case Related to COVID-19

2021 ◽  
Author(s):  
Müge Özçelik Korkmaz ◽  
Mehmet Güven
Keyword(s):  
Vocal Cord ◽  
Peripheral Nerves ◽  
Vocal Cord Paralysis ◽  
Laryngeal Nerve ◽  
Voice Therapy ◽  
Neurologic Disease ◽  
Vascular Risk ◽  
Voice Changes ◽  
History Of ◽  
Unilateral Vocal Cord Paralysis

Abstract Introduction: Although the most common neuro-otolaryngological findings associated with COVID-19 infection are chemosensory changes, it should be known that these patients may present with different clinical findings.Case summary: We present a 57-year-old woman who developed progressive hoarseness while suffering from COVID-19 infection without a history of chronic disease or any other etiological cause. Laryngeal fiberscopy revealed left vocal cord fixed at the cadaveric position and there was 5-6 mm intraglottic gap during phonation. No other etiological cause was found in the examinations performed with detailed ear nose throat examination, neurological evaluations and imaging methods. Injection laryngoplasty was applied to the patient, and voice therapy was initiated, resulting in significant improvement in voice quality.Discussion: The mechanism of the idiopatic vocal cord paralysis remains unclear, it is suspected to be related to COVID-19 neuropathy, because the patient had no preexisting vascular risk factors or evidence of other neurologic disease on neuroimaging. Laryngeal nerve palsies may represent part of the neurologic spectrum of COVID-19.Conclusion: The possibility of the peripheral nerves damage caused by SARS-CoV-2, vocal cord paralysis should be considered when voice changes occur during COVID 19 infection.

A Sudden Onset of High-Pitched Voice Associated with Unilateral Vocal Cord Paralysis: A Case Report

1974 ◽  
Vol 39 (3) ◽  
pp. 373-375 ◽  
Author(s):  
Ehud Yairi
Keyword(s):  
Case Report ◽  
Vocal Cord ◽  
Case History ◽  
Vocal Cord Paralysis ◽  
Sudden Onset ◽  
Therapeutic Procedures ◽  
History Of ◽  
Unilateral Vocal Cord Paralysis

A case history of a patient with an acquired high-pitched voice is presented, emphasizing unusual history and symptoms. Successful remediation was accomplished through traditional therapeutic procedures.

scholarly journals Factors affecting stone free rate of primary percutaneous nephrolithotomy on staghorn calculi: a single center experience of 15 years

F1000Research ◽  
2016 ◽  
Vol 5 ◽  
pp. 2106 ◽  
Author(s):  
Widi Atmoko ◽  
Ponco Birowo ◽  
Nur Rasyid
Keyword(s):  
Percutaneous Nephrolithotomy ◽  
Renal Stone ◽  
Univariate Analysis ◽  
Staghorn Calculi ◽  
Stone Burden ◽  
Stone Free Rate ◽  
History Of ◽  
Renal Stone Surgery ◽  
The Mean ◽  
Free Rate

Objectives: Percutaneous nephrolithotomy on staghorn calculi is challenging for urologists because it is difficult to remove all of the stones. The purpose of this study was to evaluate the associated factors of stone-free rate after primary percutaneous nephrolithotomy on staghorn calculi in a large series of patients at a single, tertiary referral, endourologic stone center. Methods: We collected data from medical record between January 2000 and December 2015. A total of 345 primary percutaneous nephrolithotomy procedures were performed for patients with staghorn calculi. This study included both and made no distinction between partial and complete staghorn calculi. Stone-free is defined as the absence of residual stones after undergoing percutaneous nephrolithotomy for the first time. Significant factors from univariate analysis that correlated with stone-free rate after primary percutaneous nephrolithotomy of staghorn stone were further analyzed using multivariate regression analysis. Results: The mean patient age was 52.23±10.38 years. The stone-free rate of percutaneous nephrolithotomy monotherapy was 62.6%. The mean operating time was 79.55±34.46 minutes. The mean length of stay in hospital was 4.29±3.00 days. Using the chi-square test, history of ipsilateral open renal stone surgery (p = 0.01), stone burden (p = < 0.001), and type of anesthesia (p = 0.04) had a significant impact on the stone-free. From multivariate analysis, the history of ipsilateral open renal stone surgery [OR 0.48; 95% CI 0.28-0.81; p 0.01] and the stone burden [OR 0.28; 95% CI 0.18-0.45; p 0.00] were significant independent risk factors for stone-free.

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