Long-term dysphonia may persist after thyroid surgery even in the absence of overt nerve injury. Studies evaluating this postoperative complication are generally limited by duration of follow-up or small patient cohorts.
Therefore, the objective of this work was to evaluate dysphonia after thyroidectomy using a validated survey.
| Materials and methods |
Patients who underwent thyroidectomy at a single institution between 1990 and 2018 were surveyed by telephone to complete the Voice Handicap Index-10 Survey. Individuals with documented nerve injury were excluded.
| Results |
In total, 308 patients completed the survey (mean age 51±14 years, 78% women). The median follow-up time from surgery was 10.7 years. The mean Voice Handicap Index-10 Survey score was 2.6±5.2.
195 (63%) patients reported no voice complaints after surgery. 113 (37%) patients reported subjective dysphonia. Thirty-nine (13%) patients of the total cohort reported complaints in each of the 3 response categories (functional, physical, emotional). Of these 3 categories, 19 (6.2%) reported only functional impact, 21 (6.8%) reported only physical problems, and 1 (0.3%) reported only emotional distress.
The most common complaints included “The clarity of my voice is unpredictable” (23%), “People have difficulty understanding me in a noisy room” (23%), and “I feel like I have to work hard to produce my voice” (21% ). These long-term subjective voice changes clearly affect the patient’s daily activities.
| Discussion |
It is well known that voice changes occur in case of injury to the recurrent laryngeal nerve (RLN) or superior laryngeal nerve during thyroidectomy. Several factors have been evaluated as predictive factors associated with nerve injury.
The type of surgery (lobectomy, complete thyroidectomy, or total thyroidectomy) appears to have little or no effect on the RLN injury rate. Interestingly, it was found that the type of surgery can affect subjective voice changes (complete thyroidectomy)
The findings of this work are consistent with previous studies, which show that voice changes without evidence of laryngeal nerve injury frequently occur after thyroidectomy. Most notable is that these changes can persist for many years after the index surgery. Importantly, for all patients undergoing thyroid surgery (including those who experience RLN injury), the risk of long-term subjective dysphonia is likely even higher.
Higher VHI-10 scores after thyroidectomy have been associated with several factors, including older age (-45), black race, Asian race, lateral neck dissection, and gastroesophageal reflux disease.
Postoperative complication rates have been found to be higher in patients with body mass index -30 kg/m2, neck length <6 cm, reduced neck extensibility, thyroid volume >80 ml, thyroiditis, and ultrasound evidence of thyroid hypervascularization. Doppler.
Voice changes can have a profound impact on quality of life, limiting communication, restricting participation in daily activities and social situations, and potentially affecting work performance. In this way, a voice disorder can lead to impaired function, which can ultimately contribute to disability, taking people away from their activities of daily living.
| Conclusions |
Long-term follow-up of patients after thyroidectomy suggests that more than 30% experience some long-term voice limitations.
The findings of this study highlight the need for additional research to further evaluate the etiology and impact of these changes on quality of life.
