Voice Outcomes after Total Thyroidectomy, Partial Thyroidectomy, or Non-Neck Surgery Using a Prospective Multifactorial Assessment - 20/06/14

Doi : 10.1016/j.jamcollsurg.2014.03.019

Diego A. Vicente, MD ^a, Nancy P. Solomon, PhD, CCC-SLP ^b, Itzhak Avital, MD, FACS ^f,^h, Leonard R. Henry, MD, FACS ⁱ, Robin S. Howard, MA ^c, Leah B. Helou, MA, CCC-SLP ^j, George L. Coppit, MD ^d, Craig D. Shriver, MD, FACS ^a, Chester C. Buckenmaier, MD ^e,^f, Steven K. Libutti, MD, FACS ^k, Ashok R. Shaha, MD, FACS ^l, Alexander Stojadinovic, MD, FACS ^a,^f,^g,^h,^⁎
^a Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD
^b Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD
^c Department of Research Programs, Biostatistics Section, Walter Reed National Military Medical Center, Bethesda, MD
^d Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD
^e Department of Surgery, Regional Anesthesia and Pain Management Initiative, Walter Reed National Military Medical Center, Bethesda, MD
^f Uniformed Services University of the Health Sciences, Bethesda, MD
^g United States Military Cancer Institute, Bethesda, MD
^h Bon Secours Cancer Institute, Richmond, VA
ⁱ Indiana University Health, Goshen Center for Cancer Care, Goshen, IN
^j Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
^k Department of Surgery, Montefiore Medical Center, Bronx, NY
^l Department of Surgical Oncology, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY

^∗Correspondence address: Alexander Stojadinovic, MD, FACS, Department of Surgery, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889.

Abstract

Background

Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool.

Study Design

Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups.

Results

Negative voice outcomes occurred in 46% (95% CI, 34–59%) and 14% (95% CI, 6–30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO.

Conclusions

This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.

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Abbreviations and Acronyms : CAPE-V, DSI, NegVO, NegVOobj, NegVOsubj, NN, PT, RLN, ROC, TT, VHI, VLS, VOCAL

Plan

Methods

Participants

Surgery

Participant characteristics

Voice outcomes measures

Patient characteristics

Voice outcomes measures and voice outcomes according to extent of thyroidectomy

Predictive factors for early and late negative voice outcomes

Discussion

Conclusions

Author Contributions

	Disclosure Information: Nothing to disclose.
	Supported by the United States Army's Regional Anesthesia and Pain Management Initiative and the Henry Jackson Foundation for the Advancement of Military Medicine grant number W81XWH-05-1-0047.
	The views expressed in this article are those of the authors and do not reflect the official policy of the Department of the Army, the Department of Defense, or the US Government.
	Drs Vicente, Solomon, Howard, Coppit, Shriver, Buckenmaier, and Stojadinovic are military service members or employees of the US Government; this work was prepared as part of their official duties. Title 17 USC 105 provides the “Copyright protection under this title is not available for any work of the United States Government.” Title 17 USC 101 defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person's official duties.