MRSA Thyroiditis and Thyrotoxicosis

Ear, Nose & Throat Journal, 2019

Background: Total thyroidectomy (TT) and completion thyroidectomy (CT) are two common surgical operations that are frequently followed by vocal symptoms despite preservation of the recurrent laryngeal nerve (RLN) and of the external branch of superior laryngeal nerve (EBSLN). The aim of this study was to analyze vocal alterations through endoscopic findings, videolaryngostroboscopy (VLS), acoustic vocal parameters and impact on patients’ quality of life after surgery in the absence of laryngeal nerve injury. Methods: We enrolled 198 patients who underwent thyroidectomy by the same surgeon. One hundred twenty-six patients underwent TT (group TT) while 72 underwent CT (group CT). All patients underwent preoperative VLS and Voice Handicap Index (VHI) assessment and postoperative VHI, VLS and Acoustic Voice Analysis with Multidimensional Voice Program Analysis 12 to 18 months after surgery. Results: We observed a statistically significant higher rate of EBSLN injury in CT compared to TT...

Brazilian Journal of Otorhinolaryngology, 2017

Introduction: Dysphonia is a common symptom after thyroidectomy. Objective: To analyze the vocal symptoms, auditory-perceptual and acoustic vocal, videolaryngoscopy, the surgical procedures and histopathological findings in patients undergoing thyroidectomy. Methods: Prospective study. Patients submitted to thyroidectomy were evaluated as follows: anamnesis, laryngoscopy, and acoustic vocal assessments. Moments: pre-operative, 1st post (15 days), 2nd post (1 month), 3rd post (3 months), and 4th post (6 months). Results: Among the 151 patients (130 women; 21 men). Type of surgery: lobectomy + isthmectomy n = 40, total thyroidectomy n = 88, thyroidectomy + lymph node dissection n = 23. Vocal symptoms were reported by 42 patients in the 1st post (27.8%) decreasing to 7.2% after 6 months. In the acoustic analysis, f0 and APQ were decreased in women. Videolaryngoscopies showed that 144 patients (95.3%) had normal exams in the preoperative moment. Vocal fold palsies were diagnosed in 34 paralyzes at the 1st post, 32 recurrent laryngeal nerve (lobectomy + isthmectomy n = 6; total thyroidectomy n = 17; thyroidectomy + lymph node dissection n = 9) and 2 superior laryngeal nerve (lobectomy + isthmectomy n = 1; Total thyroidectomy + lymph node dissection n = 1). After 6 months, 10 patients persisted with paralysis of the recurrent laryngeal nerve (6.6%). Histopathology and correlation with vocal fold palsy: colloid nodular goiter (n = 76; palsy n = 13), thyroiditis (n = 8; palsy n = 0), and carcinoma (n = 67; palsy n = 21).

The European Journal of Surgery, 1999

Objective: To compare clinical evaluation and indirect laryngoscopy with videolaryngostroboscopy (VLS), which is a new method of diagnosing abnormalities and dysfunction of the vocal folds. Design: Prospective study. Setting: Teaching hospital, Turkey. Subjects: 218 patients who required thyroidectomy and who had no vocal abnormality preoperatively. Interventions: Clinical evaluation, indirect laryngoscopy, and VLS before operation and on the second postoperative day. Main outcome measures: Sensitivity and specificity. Results: The specificity of all three investigations was 100%. The sensitivity of VLS was 100%, of clinical evaluation 81%, and of indirect laryngoscopy 67%. Conclusions: Clinical evaluation and indirect laryngoscopy are safe ways of evaluating abnormalities of the vocal cords postoperatively. It would probably not be cost-effective to use VLS routinely, but for differential diagnosis and evaluation of prognosis of vocal abnormalities after thyroidectomy it is more accurate.

Philippine Journal of Otolaryngology-Head and Neck Surgery, 2014

Objective: To assess effects of type 3 thyroplasty on outcomes of voice quality in puberphonia. Methods: Design: Prospective Cohort Setting: Tertiary Referral Hospital Participants: 6 patients with puberphonia who failed voice therapy, aged 16-25 years, who consulted at the ENT Outpatient department between September 2010 and September 2012, underwent type 3 thyroplasty. Pre-operative and 6-month post-operative voice analysis by voice recordings, Voice Handicap Index (VHI), GRBAS score and real time acoustic analysis (perturbation) using Dr Speech software (University version 4.0, Voice Tech Corporation, USA [Tiger Electronics]) using habitual fundamental frequency (F0), jitter % and shimmer % as parameters, were performed. Results: Mean pre-operative VHI and GRBAS scores were 53 and 75.67 respectively whereas post-operative scores were 29 and 25.00 respectively. (P-value for VHI was 0.004 and that of GRBAS was 0.00). On acoustic analysis, mean pre-operative habitual fundamental f...

Journal of Voice, 2017

This study aims to investigate early voice changes after total thyroidectomy, to assess the improved parameters in intermediate postoperative intervals, to evaluate the effect of age on voice after thyroidectomy, and to determine the correlation between the objective and the subjective method outcomes. Study Design. This is a prospective, nonrandomized study. Materials and Methods. One hundred ninety-one participants, divided into two age groups, underwent three full voice assessments (preoperatively and 1 and 8 weeks after thyroidectomy) by means of videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic evaluation, and a self-evaluation questionnaire. Two control groups enrolled in the study: (1) patients with an indication of neck surgery not related to laryngeal nerve injury risk or strap muscle dissection and (2) patients with an indication of a non-neck surgery. Results. No statistically significant difference was found in any voice parameter, between preoperative and 1-week postoperative assessment regarding the control groups. A statistically significant difference was found between preoperative evaluation and 1 week after thyroidectomy for the total study population, as well as for the ≥40 years' age subgroup for all parameters evaluated except for shimmer. The <40 years' age subgroup showed a statistically significant difference in pitch, maximum phonation time, and grade, roughness, breathiness, asthenia, and strain (GRBAS) score between preoperative evaluation and 1 week after thyroidectomy. None of the parameters showed a statistical significant difference in the <40 years' age subgroup at 8 weeks' evaluation. The Voice Handicap Index (VHI) score correlated significantly with the GRBAS score preoperatively and postoperatively at 1 and 8 weeks' evaluations. Furthermore, VHI correlated significantly with pitch a week postoperatively. GRBAS scores showed significant correlation not only with VHI but also with acoustic parameters including pitch, shimmer, and noise-to-harmonic ratio 1 and 8 weeks after thyroidectomy. Conclusions. Objective voice changes are common in the majority of the thyroidectomized patients in the early postoperative period. Our results revealed that these changes are related to thyroidectomy per se. Older patients (≥40 years of age) show acoustic and aerodynamic changes 8 weeks postoperatively, although they report no voice abnormalities and their perceptual evaluation is similar to the preoperative one.

Head & Neck, 2006

Background. Voice alterations after thyroidectomy can be found even with preserved function of laryngeal nerves. The purpose of this study was to evaluate voice before and after thyroid surgery and the role of orotracheal intubation on voice changes.

Introduction: Voice outcomes are of central importance in modern thyroid surgery. General Surgeons and Otolaryngologists (ENT) usually have different perspectives and value different criteria for successful assessment of voice issues. Objective: Describe vocal changes in thyroid surgery patients. Methods: Retrospective descriptive study for 171 patients who underwent hemi or total thyroidectomy. Vocal complaints, vocal handicap indexes (VHI) scores and laryngostroboscopic (LE) results were assessed. Results: 38% of patients reported laryngopharyngeal complaints preoperatively but only one patient had immobility. Conclusions: Care must be taken when assuming that vocal changes in thyroid surgery result only or mainly from recurrent nerve injury. From 38% of patients J Surg Res 2020; 3 (3): 236-244 Journal of Surgery and Research 237 with pre-operative vocal complaints only 0.5% of patients had immobility. Vocal changes in thyroid surgery are likely multifactorial and this study demonstrates that vocal fold immobility is not the only etiologic factor. Alternative causes for vocal changes in thyroid pathology and surgery must be investigated.

Clinical Otolaryngology, 2018

ObjectiveThe aim of this multicentric cross‐sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient&#39;s perspective.DesignThe study consisted of collecting Voice Handicap Index (VHI‐30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long‐term (&gt;2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow‐up were also analysed.SettingMulticentric study involving three tertiary European voice centres.ParticipantsForty‐nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study.Main outcome measuresThe Voice Handicap Index‐30 score.Results & ConclusionsThe median VHI was significantly different over time‐points (Friedman&#39;s test P &lt; .001), with a significant difference between pre...

Journal of The American College of Surgeons, 2004

BACKGROUND: Injury of the inferior laryngeal nerve is not the only cause of voice alteration after thyroidectomy; many patients notice minimal changes immediately after operation, without evidence of inferior laryngeal nerve damage. We hypothesized that there may be other causes for voice modification, such as injuries of the superior laryngeal nerve, prethyroid strap muscles, and cricothyroid muscles. We describe voice changes after total thyroidectomy, without inferior laryngeal nerve injury, using a computer program to objectively compare different patterns of voice. STUDY DESIGN: Forty-six consecutive patients who underwent total thyroidectomy were studied between March 1997 and December 1999. Acoustic voice analysis was performed preoperatively and at the second, fourth, and sixth postoperative months using a microphone adapted to a personal computer. Parameters measured were intensity of the voice (Shimmer) and fundamental frequency (Fo).

Journal of Voice, 2010

Introduction. Subjective nonspecific upper aerodigestive symptoms are not uncommon after thyroid surgery. These are postulated to be related to injury of an extrinsic perithyroid nerve plexus that innervates the muscles of the supraglottic and glottic larynx. This plexus is thought to receive contributing branches from both the recurrent and superior laryngeal nerves. Patients and Methods. The technique of linear predictive coding was used to estimate the F 2 values from a sustained vowel /a/ in patients before and 48 hours after thyroid or parathyroid surgery. These patients were controlled against a matched pair undergoing surgery without any theoretical effect on the supraglottic musculature. In total, 12 patients were recruited into each group. Each patient had the formant frequency fluctuation (FFF) and the formant frequency fluctuation ratio (FFFR) calculated for F 1 and F 2 .