Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma)
Abstract
:1. Introduction
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- nerve injury during TT;
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- paretic (or plegic) causes of voice damage: recurrent laryngeal nerve (RLN) paresis or superior laryngeal nerve (SLN) paresis;
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- a non-paretic cause (e.g., laryngopharyngeal reflux disease (LPRD)).
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- aero-digestive disorders: proximal acid reflux–loss of coordination of upper esophageal sphincter (UES) [10];
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- modified vascular supply and venous drainage-postoperative soft tissue edema, and mucosal edema-postintubation (orotracheal) [9];
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- local neck pain (psychological responses after surgery) [12];
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- changes in laryngeal mucosa;
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- neurogenic (psychogenic) causes.
2. Materials and Methods
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- age over 18 years;
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- preoperative normal laryngeal finding;
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- preoperatively normal voice;
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- non-physiological/pathological response obtained perioperatively at IONM;
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- postoperative change of voice.
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- age below 18 years;
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- history of any neurological disorders or diseases (e.g., multiple sclerosis);
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- any preoperative benign vocal cord lesions or other voice disorders;
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- any preoperative pathological videolaryngoscopic findings;
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- hearing loss requiring hearing aids.
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- GROUP I with movable vocal cords (verified by laryngostroboscopic examination) (without RLN paresis) n = 45;
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- GROUP II patients with postoperative unilateral transient RLN paresis n = 20.
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- Optical methods: video flexible laryngoscopy;
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- Acoustic methods: jitter (%);
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- Examination of voice field of conversational voice (determination of basic average voice position Fo (Hz) and basic sound pressure level SPL (dB (A));
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- Aerodynamic examination: maximum phonation time (MPT) (s);
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- Psychometric examination: VHI-30 (Voice Handicap Index);
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- Speech range profile (SRP) (dynamic and frequency range of speaking voice) loud reading and reading with low voice intensity not whisper.
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Parameter | n | Before | After | p |
---|---|---|---|---|
Group I women | ||||
Fmin (Hz) | 41 | 195.45 ± 70.22 | 194.59 ± 74.22 | 0.588 |
Fmax (Hz) | 41 | 256.09 ± 84.29 | 242.96 ± 87.62 | 0.001 |
Imin (dB (A)) | 41 | 59.64 ± 19.66 | 59.64 ± 19.30 | 0.423 |
Imax (dB (A)) | 41 | 74.74 ± 22.59 | 72.60 ± 21.59 | 0.001 |
Group I men | ||||
F min (Hz) | 4 | 127.35 ± 42.60 | 111.13 ± 18.03 | 0.655 |
Fmax (Hz) | 4 | 177.75 ± 60.16 | 172.25 ± 64.69 | 0.655 |
Imin (dB (A)) | 4 | 56.23 ± 3.93 | 57.13 ± 2.54 | 0.285 |
Imax (dB (A)) | 4 | 68.55 ± 4.51 | 70.73 ± 5.55 | 0.285 |
Group II women | ||||
Fmin (Hz) | 16 | 190.27 ± 24.21 | 193.43 ± 22.08 | 0.328 |
Fmax (Hz) | 16 | 249.57 ± 31.49 | 228.26 ± 18.73 | 0.005 |
Imin (dB (A)) | 16 | 54.54 ± 2.74 | 54.41 ± 3.71 | 0.477 |
Imax (dB (A)) | 16 | 68.74 ± 3.99 | 65.17 ± 6.59 | 0.034 |
Group II men | ||||
Fmin (Hz) | 4 | 118.93 ± 35.25 | 118.48 ± 31.33 | 1.000 |
Fmax (Hz) | 4 | 153.45 ± 36.70 | 140.85 ± 38.95 | 0.109 |
Imin (dB (A)) | 4 | 51.58 ± 4.45 | 51.08 ± 1.65 | 1.000 |
Imax (dB (A)) | 4 | 70.60 ± 2.37 | 64.95 ± 3.31 | 0.068 |
Female | Group I | Group II |
---|---|---|
FR (Hz) before TT (Hz) (max-min) | 60.7 (G3-C4) 5 st | 59.3 (F3#-H3) 5 st |
FR (Hz) after TT (Hz) (max-min) | 48.2 (G3-H3) 4 st | 34.8 (G3-A3) 2 st |
DR dB SPL (dB (A)) before TT (max-min) | 15.1 | 14.2 |
DR dB SPL (dB (A)) after TT (max-min) | 13.0 | 10.8 |
Difference FR (before/after TT) Difference DR (before/after TT) | −1 st −2.1 dB (SPL(A)) | −3 st −3.4 dB (SPL(A)) |
Male | Group I | Group II |
FR (Hz) before TT (max-min) | 50.4 (C3-F3) 5 st | 35.5 (A2#-D3#) 5 st |
FR (Hz) after TT (max-min) | 61.1 (A2-F3) 8 st | 22.4 (A2-C3#) 4 st |
DR dB SPL (dB (A)) before TT (max-min) | 12.3 | 19.0 |
DR dB SPL (dB (A)) after TT (max-min) | 13.6 | 13.9 |
Difference FR (before/after TT) Difference DR (before/after TT) | +3 st +1.3 dB (SPL(A)) | −1 st −5.1 dB (SPL(A)) |
Group I n = 45 | Group II n = 20 | |||
---|---|---|---|---|
Part of the VHI-30 | Before TT Average Value | After TT Average Value | Before TT Average Value | After TT Average Value |
Physical | 0.91 | 3.7 | 0.85 | 7.9 |
Functional | 0.37 | 2.3 | 1.0 | 6.3 |
Emotional | 0.24 | 1.7 | 0.4 | 3.7 |
VHI-Total (SD) | 1.6 (2.99) | 6.93 (5.95) | 2.2 (2.42) | 18.4 (19.22) |
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Veldova, Z.; Holy, R.; Rotnagl, J.; Younus, T.; Hlozek, J.; Astl, J. Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma). Int. J. Environ. Res. Public Health 2021, 18, 4300. https://doi.org/10.3390/ijerph18084300
Veldova Z, Holy R, Rotnagl J, Younus T, Hlozek J, Astl J. Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma). International Journal of Environmental Research and Public Health. 2021; 18(8):4300. https://doi.org/10.3390/ijerph18084300
Chicago/Turabian StyleVeldova, Zuzana, Richard Holy, Jan Rotnagl, Temoore Younus, Jiri Hlozek, and Jaromir Astl. 2021. "Influence of Recurrent Laryngeal Nerve Transient Unilateral Palsy on Objective Voice Parameters and on Voice Handicap Index after Total Thyroidectomy (Including Thyroid Carcinoma)" International Journal of Environmental Research and Public Health 18, no. 8: 4300. https://doi.org/10.3390/ijerph18084300