Subjective Voice Outcomes in Surgeon Versus Technician-Monitored Recurrent Laryngeal Nerves in Thyroidectomy

Objectives: To compare subjective voice outcomes and postoperative laryngoscopic examination findings of patients with subjective voice complaints between surgeon-monitored and certified technician–monitored thyroidectomies. Methods: Patients who underwent hemithyroidectomy, total thyroidectomy, and completion thyroidectomy using a nerve monitoring system between November 2015 and June 2018 were included in the study. Retrospective chart review was carried out to assess how often patients reported voice changes and to record postoperative flexible laryngoscopic findings of patients when that examination was performed. Data were analyzed using the χ2 test to identify significant differences in outcomes for the 2 groups. Results: A total of 293 procedures was performed among 3 surgeons. Surgeons monitored the nerves in 147 cases and a certified technician monitored the nerves in 146 cases. Subjective voice changes were identified in 11 (7.48%) cases in the surgeon-monitored group and in 20 (13.70%) cases in the technician-monitored group ( P = .084). Among the patients who expressed subjective voice changes, 7 patients were identified with vocal cord hypomobility or immobility in the surgeon-monitored group and 13 patients had an abnormal examination in the technician-monitored group ( P = .234). Conclusions: Subjective voice changes or proven vocal cord mobility problems were not different between surgeon-monitored patients and technician-monitored patients in thyroidectomies.

Download Full-text

Laryngeal Subsite Analysis of Granulomatosis With Polyangiitis (Wegener’s)

OTO Open ◽

10.1177/2473974x211036394 ◽

2021 ◽

Vol 5 (3) ◽

pp. 2473974X2110363

Author(s):

Natasha J. Minaya ◽

Vishwanatha Rao ◽

Matthew R. Naunheim ◽

Phillip C. Song

Keyword(s):

Vocal Fold ◽

Chart Review ◽

Granulomatosis With Polyangiitis ◽

Age At Onset ◽

Retrospective Chart Review ◽

Tertiary Referral Center ◽

Voice Changes ◽

Airway Symptoms ◽

Related Quality ◽

Underlying Mechanisms

Objective To analyze specific intralaryngeal findings associated with granulomatosis with polyangiitis (GPA). Study Design Retrospective chart review. Setting Tertiary referral center. Methods A retrospective chart review was performed on all patients diagnosed with GPA who were evaluated at the laryngology division of Massachusetts Eye and Ear Infirmary between January 2006 and September 2019. Results Forty-four patients (14 male, 30 female) were evaluated for laryngeal pathology. The mean age at onset was 48 years. Nine patients (21%) were identified with only vocal fold disease, 11 (25%) with subglottic disease, and 8 (18%) with disease at the glottis and subglottis (transglottic). The remaining 16 patients (36%) had a normal airway upon examination although they presented with laryngeal symptoms. Patients with glottic disease had statistically significantly lower voice-related quality of life scores than patients with isolated subglottic stenosis. Conclusions Although laryngeal manifestations of GPA is often described as a subglottic disease presenting with respiratory symptoms, subsite analysis show that only 25% of patients had subglottic disease alone, with similar rates of glottic disease alone. Laryngeal subsites have different epithelial mucosa, function, and physiology, and understanding the specific sites of involvement will determine symptoms and enable better analysis of the underlying mechanisms of disease. Glottic disease is associated with a reduction in vocal fold motion and voice changes. Subglottic involvement presents more frequently with airway symptoms. Further research is necessary to better define the specific regions of laryngeal involvement in patients diagnosed with GPA.

Download Full-text

Recurrent Laryngeal Nerve Preservation Strategies in Pediatric Thyroid Oncology: Continuous vs. Intermittent Nerve Monitoring

Cancers ◽

10.3390/cancers13174333 ◽

2021 ◽

Vol 13 (17) ◽

pp. 4333

Author(s):

Rick Schneider ◽

Andreas Machens ◽

Carsten Sekulla ◽

Kerstin Lorenz ◽

Henning Dralle

Keyword(s):

Vocal Cord ◽

Nerve Stimulation ◽

Vocal Cord Palsy ◽

Predictive Values ◽

Nerve Monitoring ◽

Nerve Preservation ◽

Permanent Loss ◽

Continuous Intraoperative Neuromonitoring ◽

Recurrent Laryngeal Nerves ◽

Sensitivity Specificity

(1) Background: Pediatric thyroidectomy is characterized by considerable space constraints, thinner nerves, a large thymus, and enlarged neck nodes, compromising surgical exposure. Given these challenges, risk-reduction surgery is of paramount importance in children, and even more so in pediatric thyroid oncology. (2) Methods: Children aged ≤18 years who underwent thyroidectomy with or without central node dissection for suspected or proven thyroid cancer were evaluated regarding suitability of intermittent vs. continuous intraoperative neuromonitoring (IONM) for prevention of postoperative vocal cord palsy. (3) Results: There were 258 children for analysis, 170 girls and 88 boys, with 486 recurrent laryngeal nerves at risk (NAR). Altogether, loss of signal occurred in 2.9% (14 NAR), resulting in six early postoperative vocal cord palsies, one of which became permanent. Loss of signal (3.5 vs. 0%), early (1.5 vs. 0%), and permanent (0.3 vs. 0%) postoperative vocal cord palsies occurred exclusively with intermittent IONM. With continuous nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy reached 100% for prediction of early and permanent postoperative vocal cord palsy. With intermittent nerve stimulation, sensitivity, specificity, positive and negative predictive values, and accuracy were consistently lower for prediction of early and permanent postoperative vocal cord palsy, ranging from 78.6% to 99.8%, and much lower (54.2–57.9%) for sensitivity. (4) Conclusions: Within the limitations of the study, continuous IONM, which is feasible in children ≥3 years, was superior to intermittent IONM in preventing early and permanent postoperative vocal cord palsy.

Download Full-text

Voice changes after thyroidectomy: an experience with 364 cases of thyroid surgery

International Surgery Journal ◽

10.18203/2349-2902.isj20180365 ◽

2018 ◽

Vol 5 (2) ◽

pp. 626

Author(s):

Arvind K. Prabhat ◽

Niranjan Dash ◽

J. M. Gadekar

Keyword(s):

Total Thyroidectomy ◽

Thyroid Surgery ◽

Orotracheal Intubation ◽

Age Group ◽

Completion Thyroidectomy ◽

Patient Age ◽

Voice Changes ◽

Patient Âgé ◽

Laryngeal Nerve Injury ◽

The Impact

Background: To study voice changes and to evaluate the impact of thyroidectomy and effects of factors such as patient age, sex, operation-type, surgeons-experience, laryngeal nerve injury and orotracheal intubation on voice of patients undergoing thyroidectomy.Methods: Author prospectively analyzed 364 cases of multinodular goiter (MNG) and neoplastic thyroid disorders, undergoing sub-total/total-thyroidectomy and completion-thyroidectomy in the department of surgery, during the study period of June 2016 to December 2016.Results: The study comprised of 364 patients, with 298 females and 66 males. Voice changes were seen in 216(59.34%) patients. Transient voice changes were seen in 212(98.15%) patients and permanent in 4(1.85%) patents. Out of 216 patents, age group ≥65 years were 128(59.25%) and age group <65 years were 88(40.75%) patients(p:0.012324). Out of 216 patients in which voice changes were seen,165(76.39%) patients were females and 51(23.61%) patients were males(p:0.001046). Voice changes were seen in 190(88%) patients in which sub-total/total-thyroidectomies were performed and in 26(12%) patients completion-thyroidectomies were performed. Voice changes were statistically significant in which completion-thyroidectomies were performed(p:0.002102). Voice changes were seen in 205(68.56%) cases and 11(16.92%) cases which were performed by post-graduate-trainee and experienced-surgeon respectively. Voice changes were seen in 122(67.77%) cases in which orotracheal intubation was performed and in 94(51.65%) cases cervical-epidural anaesthesia was given (p:0.00281). RLN palsy was seen in 2(0.60%) cases in which sub-total/total-thyroidectomy were performed and 2(6.25%) cases in which completion-thyroidectomy was performed (p:0.003426).Conclusions: Voice changes is common after thyroid surgery but usually transient and sometimes, permanent. So, patients must be informed about the risk of voice-impairment after thyroid surgery. Present study is novel as it investigates not only laryngeal neve injury but also highlights patient age, sex, types of operation, surgeons experience and laryngeal complications during orotracheal intubation.

Download Full-text

Effectiveness of FreeStyle Libre Flash Glucose Monitoring System Observed in Real-World, Chart Review Study in Adults with Type 2 Diabetes

10.1055/s-0039-1688212 ◽

2019 ◽

Cited By ~ 1

Author(s):

J Kröger ◽

U Aigner ◽

S Maxeiner ◽

B Paschen ◽

L Rose ◽

...

Keyword(s):

Type 2 Diabetes ◽

Monitoring System ◽

Real World ◽

Chart Review ◽

Glucose Monitoring ◽

Flash Glucose Monitoring ◽

Freestyle Libre ◽

Review Study ◽

Flash Glucose Monitoring System

Download Full-text

Bupropion treatment of youths with depressive episode: a retrospective chart review

10.26226/morressier.5785edd1d462b80296c9a2c1 ◽

2016 ◽

Author(s):

Kukju Kweon

Keyword(s):

Depressive Episode ◽

Chart Review ◽

Retrospective Chart Review

Download Full-text

Outcome of Thyroid Surgeries at Patan Hospital

Nepalese Journal of ENT Head and Neck Surgery ◽

10.3126/njenthns.v6i1.19435 ◽

2018 ◽

Vol 6 (1) ◽

pp. 11-14

Author(s):

Deepak Yadav ◽

Bhawana Dangol ◽

Anita GC ◽

Namita Shrestha ◽

Ishwor Raj Devkota ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Total Thyroidectomy ◽

Neck Dissection ◽

Recurrent Laryngeal Nerve Palsy ◽

Central Compartment ◽

Neck Surgery ◽

Laryngeal Nerve ◽

Completion Thyroidectomy ◽

Lateral Neck ◽

Lateral Neck Dissection

Objective: To assess the outcome of thyroid surgeries at Patan HospitalMaterials and Methods: It is a retrospective study of in-patient records of patients undergoing thyroid surgeries for various indications from April 2013 to January 2015 at Patan Hospital, Lalitpur.Results: During the period of 21 months, 75 patients underwent thyroid surgeries. Majority of patients underwent hemithyroidectomy (35) followed by total thyroidectomy (28), subtotal thyroidectomy (7) and completion thyroidectomy (5). Out of 28 patients undergoing total thyroidectomy (TT), 11 underwent central compartment clearance (CCC), 5 underwent CCC and lateral neck dissection. Among 5 patients undergoing completion thyroidectomy, CCC was performed in all cases and in one patient lateral neck dissection was also performed. A total of 13 patients developed unilateral recurrent laryngeal nerve palsy (RLN), among them 5 had permanent palsy. Tracheostomy had to be done in immediate postoperative period for stridor following total thyroidectomy (TT) in one case. Temporary hypocalcaemia was observed in 10 (10/28) cases following TT, out of which 8 had undergone CCC. Permanent hypocalcaemia was observed in 7 (7/28) cases following TT out of which 3 had undergone CCC. Chylous leak occurred in one of the patient undergoing left level II-IV neck dissection which was managed conservatively. None of the patient had to be transfused postoperatively.Conclusion: Complications to thyroid surgery are not uncommon. Visualization of recurrent laryngeal nerve alone in our context is adequate in experienced hands. Identification of parathyroid during thyroidectomy is recommended to avoid hypocalcaemia. Meticulous dissection can reduce the complications.Nepalese Journal of ENT Head and Neck Surgery, Vol. 6, No. 1, 2015

Download Full-text