Holler Theresa, Anderson Jennifer
Department of Otolaryngology - Head & Neck Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8C-129, Toronto, M5B 1 W8, ON, Canada.
Voice Disorders Clinic, St. Michael's Hospital, University of Toronto, 30 Bond Street, 8 Cardinal Carter North, Toronto, M5B 1 W8, ON, Canada.
J Otolaryngol Head Neck Surg. 2014 Jul 15;43(1):28. doi: 10.1186/s40463-014-0028-4.
Compressive symptoms are common in patients with thyroid disease and are an accepted indication for thyroidectomy. The objective of this study was to evaluate the prevalence and severity of voice and swallowing complaints in pre-operative thyroidectomy patients and to compare these with thyroid volume, thyroid pathology and laryngopharyngeal reflux.
A consecutive case series design was performed. All patients undergoing a thyroidectomy (partial or total) at a tertiary care centre during a 2 year period were invited to participate. Fifty nine (10 male, 49 female) aged 19-73 were enrolled (59.3% total thyroidectomy, 40.7% partial thyroidectomy). Voice and swallowing complaints were subjectively evaluated using the Voice Handicap Index (VHI) and the Modified Swallowing Impairment Score (MSIS), respectively. All patients completed the Reflux Symptom Index (RSI) and underwent videostroboscopy. Vocal function was objectively evaluated using perceptual ratings (GRBAS) and acoustic voice analysis (jitter, shimmer, maximum phonation time, maximum fundamental frequency range). The relationship between voice and swallowing symptoms was compared with thyroid volume and surgical pathology.
The average VHI score was 8.39, representing normal voice scores. Of the objective voice measures, only jitter and a subset of GRBAS measures were slightly elevated. Swallowing complaints were reported at least "some of the time" by 25 patients (41.7%), and "often or always" by 16 patients (26.7%). Of the patients with voice and swallowing complaints, 68.4% and 56%, respectively, had elevated RSI scores consistent with laryngopharyngeal reflux. No correlation was found with thyroid volume or thyroid pathology.
Swallowing complaints appear to be common in pre-operative thyroidectomy patients. A large percentage, however, have associated laryngopharyngeal reflux which may in part account for these symptoms. Patients presenting with compressive thyroid symptoms should be evaluated for laryngopharyngeal reflux, and treated where appropriate.
压迫症状在甲状腺疾病患者中很常见，是甲状腺切除术公认的指征。本研究的目的是评估术前甲状腺切除术患者声音和吞咽不适的发生率及严重程度，并将其与甲状腺体积、甲状腺病理及喉咽反流进行比较。
采用连续病例系列设计。邀请在一家三级医疗中心2年内接受甲状腺切除术（部分或全部）的所有患者参与。纳入了59例年龄在19至73岁之间的患者（10例男性，49例女性）（59.3%为全甲状腺切除术，40.7%为部分甲状腺切除术）。分别使用嗓音障碍指数（VHI）和改良吞咽障碍评分（MSIS）对声音和吞咽不适进行主观评估。所有患者均完成反流症状指数（RSI）并接受频闪喉镜检查。使用感知评分（GRBAS）和声学语音分析（抖动、闪烁、最大发声时间、最大基频范围）对嗓音功能进行客观评估。将声音和吞咽症状之间的关系与甲状腺体积和手术病理进行比较。
VHI平均得分为8.39，表明嗓音评分正常。在客观嗓音指标中，只有抖动和GRBAS指标的一个子集略有升高。25例患者（41.7%）报告至少“有时”有吞咽不适，16例患者（26.7%）报告“经常或总是”有吞咽不适。在有声音和吞咽不适的患者中，分别有68.4%和56%的患者RSI评分升高，与喉咽反流一致。未发现与甲状腺体积或甲状腺病理相关。
吞咽不适在术前甲状腺切除术患者中似乎很常见。然而，很大一部分患者伴有喉咽反流，这可能部分解释了这些症状。出现甲状腺压迫症状的患者应评估是否存在喉咽反流，并在适当情况下进行治疗。
