Department of Otolaryngology-Head and Neck Surgery, College of Medicine, 505 Banpodong Seochogu Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, 137-040, Korea.
World J Surg. 2012 Oct;36(10):2503-8. doi: 10.1007/s00268-012-1667-0.
The objectives of this study were to evaluate a screening method for detecting postoperative vocal cord palsy and lower-pitched voice and to identify how a pre-thyroidectomy laryngeal disorder affects post-thyroidectomy voice change by using our subjective voice questionnaire.
We examined 300 consecutive patients scheduled to undergo thyroidectomies between November 2010 and August 2011. Laryngoscopic examination, thyroidectomy-related voice questionnaire (TVQ) administration, and acoustic and perceptual analyses were performed preoperatively and 2 weeks after thyroidectomy.
Ninety-eight (32.6 %) patients had a preoperative laryngeal disorder. Postoperatively, 31 (10.3 %) patients had vocal cord palsy and 54 (18 %) had a lower-pitched voice 2 weeks after thyroidectomy. Postoperative TVQs classified 25 (8.4 %) patients as normal and 275 (91.6 %) patients as abnormal, including 79 (26.3 %) mild, 131 (43.6 %) moderate, and 65 (21.6 %) severe cases. Of the patients with vocal cord palsy, 80.6 % belonged to the severe group, and 92.6 % of patients with lower-pitched voices belonged to the moderate and severe groups. Fundamental frequency and speaking fundamental frequency were decreased significantly in women. The most efficient TVQ cutoff values for detecting post-thyroidectomy vocal cord palsy and postoperative lower-pitched voice were 35 (87.1 % sensitivity, 79.9 % specificity) and 25 (75.9 % sensitivity, 56.5 % specificity), respectively. Total TVQ scores increased more in the nonlaryngeal than in the laryngeal disorder group.
During the early postoperative period, 28.3 % of patients had vocal cord palsy or lower-pitched voices, which could be evaluated using a simple questionnaire. Therefore, early postoperative voice evaluation is important. Patients with nonlaryngeal disorders may be more sensitive than those with laryngeal disorders to laryngeal symptoms.
本研究旨在评估一种检测术后声带麻痹和声音低沉的筛查方法，并通过使用我们的主观嗓音问卷来确定术前喉部疾病如何影响甲状腺切除术后的嗓音变化。
我们检查了 2010 年 11 月至 2011 年 8 月期间计划行甲状腺切除术的 300 例连续患者。术前和甲状腺切除术后 2 周分别进行喉镜检查、甲状腺切除术相关嗓音问卷（TVQ）评估以及声学和感知分析。
98 例（32.6%）患者术前存在喉部疾病。术后 31 例（10.3%）患者发生声带麻痹，54 例（18%）患者术后 2 周出现声音低沉。术后 TVQ 将 25 例（8.4%）患者归类为正常，275 例（91.6%）患者归类为异常，包括 79 例（26.3%）轻度、131 例（43.6%）中度和 65 例（21.6%）重度。声带麻痹患者中，80.6%属于重度组，声音低沉的患者中，92.6%属于中重度组。女性的基频和说话基频显著降低。用于检测甲状腺切除术后声带麻痹和术后声音低沉的最有效 TVQ 截断值分别为 35（87.1%敏感性，79.9%特异性）和 25（75.9%敏感性，56.5%特异性）。非喉部疾病组的总 TVQ 评分增加更多。
术后早期，28.3%的患者出现声带麻痹或声音低沉，可通过简单的问卷进行评估。因此，术后早期的嗓音评估很重要。非喉部疾病患者对喉部症状的敏感性可能高于喉部疾病患者。
