Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery

ObjectivesHigh-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid s...

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Autores principales:	Tzu-Yen Huang, Wing-Hei Viola Yu, Feng-Yu Chiang, Che-Wei Wu, Shih-Chen Fu, An-Shun Tai, Yi-Chu Lin, Hsin-Yi Tseng, Ka-Wo Lee, Sheng-Hsuan Lin
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	thyroid surgery high-pitched voice impairment (HPVI) Index of Voice and Swallowing Handicap of Thyroidectomy (IVST) intraoperative neuromonitoring (IONM) voice stability Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/01ec5b9bf2cd4b34a2bc3e32cb366abb
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spelling	oai:doaj.org-article:01ec5b9bf2cd4b34a2bc3e32cb366abb2021-11-11T08:25:57ZCorrelation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery1664-239210.3389/fendo.2021.788878https://doaj.org/article/01ec5b9bf2cd4b34a2bc3e32cb366abb2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.788878/fullhttps://doaj.org/toc/1664-2392ObjectivesHigh-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery.MethodsThis study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient’s answers on the IVST.ResultsAs the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV.ConclusionThe factors that affect a patient’s subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.Tzu-Yen HuangTzu-Yen HuangTzu-Yen HuangWing-Hei Viola YuFeng-Yu ChiangFeng-Yu ChiangChe-Wei WuChe-Wei WuShih-Chen FuShih-Chen FuAn-Shun TaiAn-Shun TaiYi-Chu LinHsin-Yi TsengKa-Wo LeeKa-Wo LeeSheng-Hsuan LinSheng-Hsuan LinSheng-Hsuan LinSheng-Hsuan LinFrontiers Media S.A.articlethyroid surgeryhigh-pitched voice impairment (HPVI)Index of Voice and Swallowing Handicap of Thyroidectomy (IVST)intraoperative neuromonitoring (IONM)voice stabilityDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	thyroid surgery high-pitched voice impairment (HPVI) Index of Voice and Swallowing Handicap of Thyroidectomy (IVST) intraoperative neuromonitoring (IONM) voice stability Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	thyroid surgery high-pitched voice impairment (HPVI) Index of Voice and Swallowing Handicap of Thyroidectomy (IVST) intraoperative neuromonitoring (IONM) voice stability Diseases of the endocrine glands. Clinical endocrinology RC648-665 Tzu-Yen Huang Tzu-Yen Huang Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Feng-Yu Chiang Che-Wei Wu Che-Wei Wu Shih-Chen Fu Shih-Chen Fu An-Shun Tai An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Ka-Wo Lee Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
description	ObjectivesHigh-pitched voice impairment (HPVI) is not uncommon in patients without recurrent laryngeal nerve (RLN) or external branch of superior laryngeal nerve (EBSLN) injury after thyroidectomy. This study evaluated the correlation between subjective and objective HPVI in patients after thyroid surgery.MethodsThis study analyzed 775 patients without preoperative subjective HPVI and underwent neuromonitored thyroidectomy with normal RLN/EBSLN function. Multi-dimensional voice program, voice range profile and Index of voice and swallowing handicap of thyroidectomy (IVST) were performed during the preoperative(I) period and the immediate(II), short-term(III) and long-term(IV) postoperative periods. The severity of objective HPVI was categorized into four groups according to the decrease in maximum frequency (Fmax): <20%, 20-40%, 40-60%, and >60%. Subjective HPVI was evaluated according to the patient’s answers on the IVST.ResultsAs the severity of objective HPVI increased, patients were significantly more to receive bilateral surgery (p=0.002) and have subjective HPVI (p<0.001), and there was no correlation with IVST scores. Among 211(27.2%) patients with subjective HPVI, patients were significantly more to receive bilateral surgery (p=0.003) and central neck dissection(p<0.001). These patients had very similar trends for Fmax, pitch range, and mean fundamental frequency as patients with 20-40% Fmax decrease (p>0.05) and had higher Jitter, Shimmer, and IVST scores than patients in any of the objective HPVI groups; subjective HPVI lasted until period-IV.ConclusionThe factors that affect a patient’s subjective HPVI are complex, and voice stability (Jitter and Shimmer) is no less important than the Fmax level. When patients have subjective HPVI without a significant Fmax decrease after thyroid surgery, abnormal voice stability should be considered and managed. Fmax and IVST scores should be interpreted comprehensively, and surgeons and speech-language pathologists should work together to identify patients with HPVI early and arrange speech therapy for them. Regarding the process of fibrosis formation, anti-adhesive material application and postoperative intervention for HPVI require more future research.
format	article
author	Tzu-Yen Huang Tzu-Yen Huang Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Feng-Yu Chiang Che-Wei Wu Che-Wei Wu Shih-Chen Fu Shih-Chen Fu An-Shun Tai An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Ka-Wo Lee Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin
author_facet	Tzu-Yen Huang Tzu-Yen Huang Tzu-Yen Huang Wing-Hei Viola Yu Feng-Yu Chiang Feng-Yu Chiang Che-Wei Wu Che-Wei Wu Shih-Chen Fu Shih-Chen Fu An-Shun Tai An-Shun Tai Yi-Chu Lin Hsin-Yi Tseng Ka-Wo Lee Ka-Wo Lee Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin Sheng-Hsuan Lin
author_sort	Tzu-Yen Huang
title	Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
title_short	Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
title_full	Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
title_fullStr	Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
title_full_unstemmed	Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery
title_sort	correlation between objective and subjective high-pitched voice impairment in patients after thyroid surgery
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/01ec5b9bf2cd4b34a2bc3e32cb366abb
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Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery

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