Randolph Gregory W, Sritharan Niranjan, Song Phil, Franco Ramon, Kamani Dipti, Woodson Gayle
1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
2Division of Surgical Oncology, Endocrine Surgical Service, Massachusetts General Hospital, Boston, Massachusetts.
Thyroid. 2015 Jun;25(6):665-71. doi: 10.1089/thy.2014.0467. Epub 2015 Apr 14.
Voice changes commonly occur from thyroidectomy and may be due to neural or nonneural causes. Such changes can be a source of significant morbidity for any patient, but thyroidectomy in the professional singer carries special significance. We test the hypothesis that the career of singers and professional voice users is not impaired after neural monitored thyroid surgery.
A quantitative analysis of pre- and postoperative neural monitored thyroid surgery voice outcomes utilizing three validated vocal instruments-Voice Handicap Index (VHI), Singing Voice Handicap Index (SVHI), and Evaluation of Ability to Sing Easily (EASE)-in a unique series of professional singers/voice users was performed. Additional quantitative analysis related to final intraoperative electromyography (EMG) amplitude, the time to return to performance, and vocal parameters affected during this interval was performed.
Twenty-seven vocal professionals undergoing thyroidectomy were identified, of whom 60% had surgery for thyroid cancer. Pre- and postsurgery flexible fiberoptic laryngeal exams were normal in all patients. Return to performance rate was 100%, and mean time to performance was 2.26 months (±1.61). All three vocal instrument mean scores, pre-op vs. post-op, were unchanged: VHI, 4.15 (±5.22) vs. 4.04 (±3.85), p=0.9301; SVHI, 11.26 (±14.41) vs.12.07 (±13.09), p=0.8297; and EASE, 6.19 (±9.19) vs. 6.00 (±7.72), p=0.9348. The vocal parameters most affected from surgery until first performances were vocal fatigue (89%), high range (89%), pitch control and modulation (74%), and strength (81%). Final mean intraoperative EMG amplitude was within normal limits for intraoperative stimulation and had no relationship with time to first professional performance (p=0.7199).
Neural monitored thyroidectomy, including for thyroid malignancy, in professional voice users is safe without any changes in three different voice/singing instruments, with 100% return to performance. Intraoperative EMG data at the conclusion of surgery and postoperative laryngeal exam were normal in all patients. Specific vocal parameters are transiently affected during the postoperative recovery phase, which is important to outline in the consent process of this unique patient population and may provide insight into the physiologic state of the larynx subsequent to thyroid surgery.
甲状腺切除术后常出现嗓音变化，可能由神经或非神经原因引起。这种变化对任何患者来说都可能是严重发病的根源，但对于职业歌手而言，甲状腺切除术具有特殊意义。我们检验了这样一个假设：在神经监测下进行甲状腺手术后，歌手和职业用嗓者的职业生涯不会受到损害。
利用三种经过验证的嗓音评估工具——嗓音障碍指数（VHI）、歌唱嗓音障碍指数（SVHI）和轻松歌唱能力评估（EASE），对一系列独特的职业歌手/用嗓者在神经监测下甲状腺手术前后的嗓音结果进行了定量分析。还进行了与术中最终肌电图（EMG）振幅、恢复演出时间以及在此期间受影响的嗓音参数相关的额外定量分析。
确定了27名接受甲状腺切除术的嗓音专业人士，其中60%因甲状腺癌接受手术。所有患者术前和术后的软性纤维喉镜检查均正常。恢复演出率为100%，平均恢复演出时间为2.26个月（±1.61）。术前与术后，三种嗓音评估工具的平均得分均无变化：VHI，4.15（±5.22）对4.04（±3.85），p = 0.9301；SVHI，11.26（±14.41）对12.07（±13.09），p = 0.8297；EASE，6.19（±9.19）对6.00（±7.72），p = 0.9348。从手术到首次演出期间受影响最大的嗓音参数是嗓音疲劳（89%）、高音域（89%）、音高控制和调制（74%）以及力度（81%）。术中最终EMG振幅在术中刺激的正常范围内，且与首次职业演出时间无关（p = 0.7199）。
对于职业用嗓者，包括因甲状腺恶性肿瘤进行的神经监测下甲状腺切除术是安全的，三种不同的嗓音/歌唱评估工具均无变化，恢复演出率达100%。所有患者手术结束时的术中EMG数据及术后喉镜检查均正常。特定的嗓音参数在术后恢复阶段会受到短暂影响，这在针对这一独特患者群体的知情同意过程中很重要，且可能有助于深入了解甲状腺手术后喉部的生理状态。
