Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma)
, Richard Holy 1,2,*, Jan Rotnagl 1,2, Temoore Younus 1,2, Jiri Hlozek 1,2 and Jaromir Astl 1,2Round 1
Reviewer 1 Report
Good work.
Some little english mistakes in the text that authors should review.
In the introduction, the importance of dysphonia must be underlined by news references that evidenced psychological and balance distress.
About this, i tell you to mention in your text and among the references this work:
- Bruno G, Melissa S, Natalia C, Francesco G, Francesco F, Rocco B, Patrizia L, Antonella P, Ettore C, Zhang D, Gianlorenzo D, Francesco G. Posture and dysphonia associations in patients undergoing total thyroidectomy: stabilometric analysis. Updates Surg. 2020 Dec;72(4):1143-1149.
About the material, why do you use the VHI questionnaire? This choice is correct but a comparison with another test (e.g. VOISS and VTDS) is necessary. Please explain it and mention about this, the work:
- Galletti B, Sireci F, Mollica R, Iacona E, Freni F, Martines F, Scherdel EP, Bruno R, Longo P, Galletti F. Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders. Int Arch Otorhinolaryngol. 2020 Jul;24(3):e323-e329.
The reference N° 10 is not relevant and therefore must be removed and/or replaced
Author Response
We have accepted all your comments. Thank you for your recommendation.
Reviewer I
Good work.
Some little english mistakes in the text that authors should review.
In the introduction, the importance of dysphonia must be underlined by news references that evidenced psychological and balance distress.
About this, i tell you to mention in your text and among the references this work:
- Bruno G, Melissa S, Natalia C, Francesco G, Francesco F, Rocco B, Patrizia L, Antonella P, Ettore C, Zhang D, Gianlorenzo D, Francesco G. Posture and dysphonia associations in patients undergoing total thyroidectomy: stabilometric analysis. Updates Surg. 2020 Dec;72(4):1143-1149.
Accepted added text and reference.
About the material, why do you use the VHI questionnaire? This choice is correct but a comparison with another test (e.g. VOISS and VTDS) is necessary. Please explain it and mention about this, the work:
- Galletti B, Sireci F, Mollica R, Iacona E, Freni F, Martines F, Scherdel EP, Bruno R, Longo P, Galletti F. Vocal Tract Discomfort Scale (VTDS) and Voice Symptom Scale (VoiSS) in the Early Identification of Italian Teachers with Voice Disorders. Int Arch Otorhinolaryngol. 2020 Jul;24(3):e323-e329.
- Accepted added text and reference
The reference N° 10 is not relevant and therefore must be removed and/or replaced - Accepted, removed
Reviewer 2 Report
not adding any particular insights to literature
not worth of publication
Not useful in terms of knowledge of the problem and in terms of potential solution to the vocal complication
Author Response
Thank you for your feedback. We are sorry that our manuscript did not convince you of the quality.
Reviewer 3 Report
This manuscript is interesting and well made by the authors. They explain in detail each variable, that are shown in the tables. I have some questions about this manuscript:
Page 2. “especially vocal professionals” 1. What were the professions related in their study? Page 3. “Exclusion criteria, “preoperative pathological” Which were the pathological findings observed by videolaryngoscopic? Why did the authors consider to include this variable as an exclusion criteria? Will it be possible to explain the relationship between RLN and TT surgery in association to medullar carcinoma and papillary carcinoma?
How many subtypes of papillary carcinoma did the authors find?
Were the thyroid carcinomas related to major damage of RLN after surgery or were indistinct between the other diseases?
The patient with medullary carcinoma had some other diseases related to carcinoma (for example: NEM2A or B, Hirschsprung’s disease) could that affect the surgery? Otherwise, could it be related with RLN damage? 3. Results.
The results obtained by transient RLN paresis (n=20) are similar to explain in the methodology (GROUP II), please do not repeat this value in order to avoid confusions. 4. The discussion and conclusion are well made. Overall comments This manuscript is interesting and well redacted, the authors give relevant information regarding the damage of RLN after a thyroidectomy. This manuscript provides new insights that will be important for further research, however, it could be interesting that the authors explain specifically the relationship between damage of RLN and thyroid carcinoma, mainly with the medullary carcinoma.
Author Response
We have received all your comments in the attachment we are replying to. Thank you for your recommendation.
Author Response File: 
Author Response.pdf
Reviewer 4 Report
The authors present the results of a retrospective cohort of 65 patients treated with total thyroidectomy in the time frame 2018-2019/2020?. They divided the population in two groups based on RLN paresis, and assessing voice quality before and 14 days post-op by using different methods (objective and subjective)
Abstract
Page 1: abbreviations of “total thyroidectomy” would be “TT” and not “TTE”, please correct
Material and methods
Page 2: in the abstract Authors declare that patients were treated between 2018 and 2019, here between 2018 and 2020. Please correct
Page 3: Authors divided the cohort based on RLN paresis, single nerve! Did they have only unilateral paresis? If not, please specify in exclusion criteria
Page 3: Why did the Authors choose 14 days cut-off? “All patients underwent the following examinations - before TTE and check-up within 14 days after TTE.” Please explain and/or provide references.
Page 3: please provide appropriate references regarding the VHI questionnaires and validation in Czech language.
Page 3: “Examination of voice field of conversational voice (determination of basic average voice position Fo (Hz) and basic sound pressure level SPL [dB (A)]” Brackets has been opened but not closed, please correct
Results:
Page 4: Authors declare that all paresis resolved within 6 weeks. Why did they give us this information? The aim of the study is to evaluate voice quality before and “SHORTLY” post-op. Furthermore even in group I (without RLN paresis) have been registered voice disordered. Please explain.
Page 6: Voice quality returned to normal in 64% of patients Group I. and 15% of patients Group II. after function resumed. In the rest of the patients, non-paretic causes of voice disturbance, notably Aero-digestive disorders (LPRD) and external branch superior laryngeal nerve paresis (EBSLNp), contributed to persistent impaired voice quality. EBSLNp causing limitation of m.cricothyroideus function (stretching muscle) leading to limitation of the ability to modulate voice and inability to speak aloud. How did Authors arrive at these conclusions? How did they define “normal” in group I only with laryngoscopy? How did they conclude that patients are affected by reflux? Did they administer proton pump inhibitor drugs or did they perform a pH monitoring?
Typo, almost in all the paper: the dot after group I and/or II, please correct.
Sincerely your reviewer
Author Response
Dear Reviewer,
Thank you for your recommendation.
We have received all your comments in the attachment we are replying to.
Author Response File: Author Response.pdf
