scholarly journals Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters

2021 ◽  
Vol 12 ◽  
Author(s):  
Tzu-Yen Huang ◽  
Wing-Hei Viola Yu ◽  
Feng-Yu Chiang ◽  
Che-Wei Wu ◽  
Shih-Chen Fu ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Vocal Fold ◽  
Thermal Injury ◽  
Prognostic Indicator ◽  
Intraoperative Neuromonitoring ◽  
Injury Mechanism ◽  
Prognostic Indicators ◽  
Pitch Range ◽  
Vocal Fold Motion

ObjectivesIn patients with recurrent laryngeal nerve (RLN) injury after thyroid surgery, unrecovered vocal fold motion (VFM) and subjective voice impairment cause extreme distress. For surgeons, treating these poor outcomes is extremely challenging. To enable early treatment of VFM impairment, this study evaluated prognostic indicators of non-transection RLN injury and VFM impairment after thyroid surgery and evaluated correlations between intraoperative neuromonitoring (IONM) findings and perioperative voice parameters.Methods82 adult patients had postoperative VFM impairment after thyroidectomy were enrolled. Demographic characteristics, RLN electromyography (EMG), and RLN injury mechanism were compared. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were administered during I-preoperative; II-immediate, III-short-term and IV-long-term postoperative periods. The patients were divided into R/U Group according to the VFM was recovered/unrecovered 3 months after surgery. The patients in U Group were divided into U1/U2 Group according to total IVST score change was <4 and ≥4 during period-IV.ResultsCompared to R Group (42 patients), U Group (38 patients) had significantly more patients with EMG >90% decrease in the injured RLN (p<0.001) and thermal injury as the RLN injury mechanism (p=0.002). Voice parameter impairments were more severe in U Group compared to R Group. Compared to U1 group (19 patients), U2 Group (19 patients) had a significantly larger proportion of patients with EMG decrease >90% in the injured RLN (p=0.022) and thermal injury as the RLN injury mechanism (p=0.017). A large pitch range decrease in period-II was a prognostic indicator of a moderate/severe long-term postoperative subjective voice impairment.ConclusionThis study is the first to evaluate correlations between IONM findings and voice outcomes in patients with VFM impairment after thyroid surgery. Thyroid surgeons should make every effort to avoid severe type RLN injury (e.g., thermal injury or injury causing EMG decrease >90%), which raises the risk of unrecovered VFM and moderate/severe long-term postoperative subjective voice impairment. Using objective voice parameters (e.g., pitch range) as prognostic indicators not only enables surgeons to earlier identify patients with low voice satisfaction after surgery, and also enable implementation of interventions sufficiently early to maintain quality of life.

scholarly journals How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice

Cancers ◽  
2021 ◽  
Vol 13 (21) ◽  
pp. 5379
Author(s):  
Tzu-Yen Huang ◽  
Wing-Hei Viola Yu ◽  
Feng-Yu Chiang ◽  
Che-Wei Wu ◽  
Shih-Chen Fu ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Vocal Fold ◽  
Thermal Injury ◽  
Mechanical Injury ◽  
Injury Mechanisms ◽  
Group A ◽  
Nerve Dysfunction ◽  
Vocal Fold Motion ◽  
Swallowing Outcomes

Intraoperative neuromonitoring can qualify and quantify RLN function during thyroid surgery. This study investigated how the severity and mechanism of RLN dysfunction during monitored thyroid surgery affected postoperative voice. This retrospective study analyzed 1021 patients that received standardized monitored thyroidectomy. Patients had post-dissection RLN(R2) signal <50%, 50–90% and >90% decrease from pre-dissection RLN(R1) signal were classified into Group A-no/mild, B-moderate, and C-severe RLN dysfunction, respectively. Demographic characteristics, RLN injury mechanisms(mechanical/thermal) and voice analysis parameters were recorded. More patients in the group with higher severity of RLN dysfunction had malignant pathology results (A/B/C = 35%/48%/55%, p = 0.017), received neck dissection (A/B/C = 17%/31%/55%, p < 0.001), had thermal injury (p = 0.006), and had asymmetric vocal fold motion in long-term postoperative periods (A/B/C = 0%/8%/62%, p < 0.001). In postoperative periods, Group C patients had significantly worse voice outcomes in several voice parameters in comparison to Group A/B. Thermal injury was associated with larger voice impairments compared to mechanical injury. This report is the first to discuss the severity and mechanism of RLN dysfunction and postoperative voice in patients who received monitored thyroidectomy. To optimize voice and swallowing outcomes after thyroidectomy, avoiding thermal injury is mandatory, and mechanical injury must be identified early to avoid a more severe dysfunction.

The Utility of Evaluating True Vocal Fold Motion Before Thyroid Surgery

2006 ◽  
Vol 116 (2) ◽  
pp. 235-238 ◽  
Author(s):  
Tarik Y. Farrag ◽  
Robin A. Samlan ◽  
Frank R. Lin ◽  
Ralph P. Tufano
Keyword(s):  
Thyroid Surgery ◽  
Vocal Fold ◽  
Vocal Fold Motion

Management of Adult Vocal Fold Nerve Injury

2009 ◽  
Vol 19 (1) ◽  
pp. 24-33
Author(s):  
Peak Woo ◽  
Linda M. Carroll
Keyword(s):  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Prognostic Indicators ◽  
Team Management ◽  
Short Term ◽  
Best Management ◽  
Speech Language Pathologist ◽  
Surgical Options

Abstract Diagnosis and management of nerve impairment in adults can be difficult due to the myriad of other diagnoses that must be considered. Accurate diagnosis of severity of a nerve impairment and determination of prognostic indicators for return of adequate function are paramount to best management. The strongest prognostic test of nerve function is electromyography. Team management by an otolaryngologist and speech-language pathologist of vocal fold paralysis needs to be sensitive to the patient's needs, both short-term and long-term. This article summarizes the current diagnostic tests and options. Case studies are included to guide the reader through team management and surgical options.

Suspension microlaryngoscopic surgery and indirect microlaryngostroboscopic surgery for benign lesions of the vocal folds

1994 ◽  
Vol 108 (12) ◽  
pp. 1064-1067 ◽  
Author(s):  
F. G. Dikkers ◽  
A. M. Sulter
Keyword(s):  
Vocal Fold ◽  
Functional Result ◽  
Benign Lesion ◽  
Vocal Folds ◽  
Benign Lesions ◽  
Intensity Maximum ◽  
Pitch Range ◽  
Intensity Range ◽  
A Prospective Study

AbstractA prospective study was designed to compare the effects on voice capacities after either suspension microlaryngoscopic surgery or indirect microlaryngostroboscopic surgery. Patients where the clinical diagnosis 'dysphonia due to a benign lesion of the vocal fold' was made, and who could be operated in either way, entered the study. Post-operative voice evaluation was performed on 21 patients after suspension microlaryngoscopic or indirect microlaryngostroboscopic surgery. The long-term voice results following indirect microlaryngostroboscopic surgery and suspension microlaryngoscopic surgery demonstrate a statistically significant improvement for the maximum intensity, maximum dynamic intensity range, dynamic intensity range at habitual speaking pitch, and melodic pitch range. In selected cases indirect microlaryngostroboscopic surgery offers a very good functional result.

P15-F Intraoperative-neuromonitoring-recording effectiveness of the laryngeal-adductor-reflex (LAR) during thyroid surgery: Immediate and long-term EMG-ENT outcome correlation

2019 ◽  
Vol 130 (7) ◽  
pp. e71
Author(s):  
Vizmary J. Montes Pena ◽  
Jose L. Boada Cuellar ◽  
Beira Guzman Carreras ◽  
Alfonso Millera Escarlatin ◽  
Javier Deus Fombellida ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Adductor Reflex

scholarly journals Paradoxical vocal fold motion: respiratory retraining to manage long-term symptoms

2012 ◽  
Vol 24 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Victoria Hatzelis ◽  
Thomas Murry
Keyword(s):  
Vocal Fold ◽  
Laryngopharyngeal Reflux ◽  
Extended Period ◽  
Vocal Folds ◽  
Post Treatment ◽  
Shortness Of Breath ◽  
Patient Reported ◽  
Vocal Fold Motion ◽  
Paradoxical Vocal Fold Motion

Paradoxical vocal fold motion (PVFM) is a laryngeal disorder characterized by abnormal adduction of the vocal folds during respiration. It is caused by a multitude of etiologies and their interactions. In the current study, a 24-year-old female patient with a 12-year complaint of shortness of breath was diagnosed with paradoxical vocal fold motion following nasal endoscopy, spirometry testing and detailed case history analysis. She had no history or indication of laryngopharyngeal reflux or chronic cough. She performed respiratory retraining exercises three to four times daily for a period of four weeks, and continued daily exercises for two additional months as needed. After four weeks of treatment, abnormal vocal fold adduction continued to be seen on endoscopy and the patient was mildly symptomatic. One month post-treatment, there was no abnormal vocal fold adduction and the patient reported rare shortness of breath. At three months post-treatment, there was no abnormal vocal fold adduction and the patient no longer reported shortness of breath. She reported normal breathing with no symptoms one year later. The results suggest that non-pulmonary related shortness of breath treated with respiratory retraining can effectively eliminate dyspnea in patients with long term breathing difficulties caused by paradoxical vocal fold motion. Resolution may require treatment over an extended period of time.

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