Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters
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...
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Frontiers Media S.A.
2021
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oai:doaj.org-article:d92e14eb7bcd445ba4dc6f9e7e60bc3b2021-12-01T18:17:10ZPrognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters1664-239210.3389/fendo.2021.755231https://doaj.org/article/d92e14eb7bcd445ba4dc6f9e7e60bc3b2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fendo.2021.755231/fullhttps://doaj.org/toc/1664-2392ObjectivesIn 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.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 surgeryintraoperative neuromonitoring (IONM)vocal fold motionrecurrent laryngeal nerve (RLN)index of voice and swallowing handicap of thyroidectomy (IVST)subjective/objective voice analysisDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENFrontiers in Endocrinology, Vol 12 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
thyroid surgery intraoperative neuromonitoring (IONM) vocal fold motion recurrent laryngeal nerve (RLN) index of voice and swallowing handicap of thyroidectomy (IVST) subjective/objective voice analysis Diseases of the endocrine glands. Clinical endocrinology RC648-665 |
| spellingShingle |
thyroid surgery intraoperative neuromonitoring (IONM) vocal fold motion recurrent laryngeal nerve (RLN) index of voice and swallowing handicap of thyroidectomy (IVST) subjective/objective voice analysis 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 Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| description |
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. |
| 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 |
Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| title_short |
Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| title_full |
Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| title_fullStr |
Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| title_full_unstemmed |
Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery – Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters |
| title_sort |
prognostic indicators of non-transection nerve injury and vocal fold motion impairment after thyroid surgery – correlation between intraoperative neuromonitoring findings and perioperative voice parameters |
| publisher |
Frontiers Media S.A. |
| publishDate |
2021 |
| url |
https://doaj.org/article/d92e14eb7bcd445ba4dc6f9e7e60bc3b |
| work_keys_str_mv |
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