Wong Kai-Pun, Au Kin-Pan, Lam Shi, Lang Brian Hung-Hin
Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong , Queen Mary Hospital, Hong Kong SAR, China .
Thyroid. 2017 Jan;27(1):88-94. doi: 10.1089/thy.2016.0407.
Patients with hoarseness of voice, previous neck operation, or suspicion of malignancy are at high risk of having pre-thyroidectomy vocal cord (VCP) palsy. Therefore, vocal cord (VC) functions should be evaluated before surgery. This study aimed to evaluate the accuracy of hoarseness, a voice-related questionnaire (Voice Handicap Index [VHI]-30), and transcutaneous laryngeal ultrasound (TLUSG) in diagnosing VCP, as well as the role of TLUSG in the evaluation of high-risk patients.
A total of 1000 patients undergoing thyroidectomy or other endocrine-related neck procedures were prospectively included. Symptoms of hoarseness, the VHI-30 score, and TLUSG were evaluated. Validation laryngoscopies were performed by a separate endoscopist after performing TLUSG. All the assessments were performed one to seven days before surgery. The findings of hoarseness, the VHI-30 score, and TLUSG were correlated with laryngoscopic findings to evaluate the diagnostic accuracy.
Of 1000 patients, nine preoperative VCP were diagnosed with laryngoscopy. Sensitivity in detecting VCP by hoarseness, the VHI-30 score, and TLUSG were 33.3%, 62.5%, and 88.9%, respectively. A total of 342 patients were considered as high risk, and eight preoperative VCP were confirmed with laryngoscopy. Despite it not being possible to visualize the VCs in 26 (7.7%) patients, TLUSG had a higher accuracy in detecting VCP than the VHI-30 did (96.8% vs. 74.2%; p < 0.001). If patients had been selected who were unassessable or who had had VCP on assessment for confirmatory laryngoscopy, TLUSG saved more patients from laryngoscopic examinations than the VHI-30 did (87.7% vs. 71.3%; p < 0.001). A history of neck operation and suspicion of malignancy did not affect the assessment by TLUSG (p > 0.05).
TLUSG is a feasible, non-invasive, and sensitive tool in detecting VCP in high-risk patients. It has safely precluded 87.7% high-risk patients from laryngoscopy. TLUSG should be incorporated as a part of the ultrasound examination of the thyroid.
声音嘶哑、既往有颈部手术史或怀疑有恶性肿瘤的患者术前发生声带麻痹的风险较高。因此，手术前应评估声带功能。本研究旨在评估声音嘶哑、一种与嗓音相关的问卷（嗓音障碍指数[VHI]-30）和经皮喉超声（TLUSG）在诊断声带麻痹方面的准确性，以及TLUSG在高危患者评估中的作用。
前瞻性纳入1000例行甲状腺切除术或其他内分泌相关颈部手术的患者。评估声音嘶哑症状、VHI-30评分和TLUSG。在进行TLUSG后，由另一位内镜医师进行验证性喉镜检查。所有评估均在手术前1至7天进行。将声音嘶哑、VHI-30评分和TLUSG的结果与喉镜检查结果进行关联，以评估诊断准确性。
1000例患者中，9例术前声带麻痹经喉镜检查确诊。声音嘶哑、VHI-30评分和TLUSG检测声带麻痹的敏感性分别为33.3%、62.5%和88.9%。共有342例患者被视为高危患者，8例术前声带麻痹经喉镜检查确诊。尽管26例（7.7%）患者无法观察到声带，但TLUSG检测声带麻痹的准确性高于VHI-30（96.8%对74.2%；p<0.001）。如果选择那些无法评估或评估时有声带麻痹的患者进行验证性喉镜检查，TLUSG比VHI-30能使更多患者免于喉镜检查（87.7%对71.3%；p<0.001）。颈部手术史和怀疑有恶性肿瘤并不影响TLUSG的评估（p>0.05）。
TLUSG是检测高危患者声带麻痹的一种可行、无创且敏感的工具。它已使87.7%的高危患者安全地免于喉镜检查。TLUSG应作为甲状腺超声检查的一部分。
