Papadakis Chariton E, Asimakopoulou Panagiota, Proimos Efklidis, Perogamvrakis George, Papoutsaki Effrosyni, Chimona Theognosia
Otolaryngology Department, General Hospital of Chania, Chania, Greece.
Otolaryngology Department, General Hospital of Chania, Chania, Greece.
J Voice. 2017 Jul;31(4):515.e15-515.e21. doi: 10.1016/j.jvoice.2016.12.011. Epub 2017 Feb 3.
This study aims to investigate early voice changes after total thyroidectomy, to assess the improved parameters in intermediate postoperative intervals, to evaluate the effect of age on voice after thyroidectomy, and to determine the correlation between the objective and the subjective method outcomes.
This is a prospective, nonrandomized study.
One hundred ninety-one participants, divided into two age groups, underwent three full voice assessments (preoperatively and 1 and 8 weeks after thyroidectomy) by means of videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic evaluation, and a self-evaluation questionnaire. Two control groups enrolled in the study: (1) patients with an indication of neck surgery not related to laryngeal nerve injury risk or strap muscle dissection and (2) patients with an indication of a non-neck surgery.
No statistically significant difference was found in any voice parameter, between preoperative and 1-week postoperative assessment regarding the control groups. A statistically significant difference was found between preoperative evaluation and 1 week after thyroidectomy for the total study population, as well as for the ≥40 years' age subgroup for all parameters evaluated except for shimmer. The <40 years' age subgroup showed a statistically significant difference in pitch, maximum phonation time, and grade, roughness, breathiness, asthenia, and strain (GRBAS) score between preoperative evaluation and 1 week after thyroidectomy. None of the parameters showed a statistical significant difference in the <40 years' age subgroup at 8 weeks' evaluation. The Voice Handicap Index (VHI) score correlated significantly with the GRBAS score preoperatively and postoperatively at 1 and 8 weeks' evaluations. Furthermore, VHI correlated significantly with pitch a week postoperatively. GRBAS scores showed significant correlation not only with VHI but also with acoustic parameters including pitch, shimmer, and noise-to-harmonic ratio 1 and 8 weeks after thyroidectomy.
Objective voice changes are common in the majority of the thyroidectomized patients in the early postoperative period. Our results revealed that these changes are related to thyroidectomy per se. Older patients (≥40 years of age) show acoustic and aerodynamic changes 8 weeks postoperatively, although they report no voice abnormalities and their perceptual evaluation is similar to the preoperative one.
本研究旨在调查全甲状腺切除术后早期的嗓音变化，评估术后中期改善的参数，评估年龄对甲状腺切除术后嗓音的影响，并确定客观方法与主观方法结果之间的相关性。
这是一项前瞻性、非随机研究。
191名参与者分为两个年龄组，通过视频频闪喉镜检查、感知评估、声学分析、空气动力学评估和一份自我评估问卷进行三次全面的嗓音评估（术前以及甲状腺切除术后1周和8周）。研究纳入了两个对照组：（1）有颈部手术指征但无喉返神经损伤风险或带状肌解剖的患者；（2）有非颈部手术指征的患者。
对照组术前与术后1周的任何嗓音参数均未发现统计学上的显著差异。对于整个研究人群以及除闪烁度外所有评估参数的≥40岁年龄亚组，术前评估与甲状腺切除术后1周之间发现有统计学上的显著差异。<40岁年龄亚组在术前评估与甲状腺切除术后1周之间，音高、最大发声时间以及等级、粗糙度、气息声、无力和紧张（GRBAS）评分存在统计学上的显著差异。在8周评估时，<40岁年龄亚组的参数均未显示出统计学上的显著差异。嗓音障碍指数（VHI）评分在术前以及术后1周和8周评估时均与GRBAS评分显著相关。此外，VHI在术后1周与音高显著相关。GRBAS评分不仅与VHI显著相关，还与甲状腺切除术后1周和8周的声学参数（包括音高、闪烁度和噪声谐波比）显著相关。
在大多数甲状腺切除术后患者的术后早期，客观嗓音变化很常见。我们的结果表明，这些变化与甲状腺切除术本身有关。老年患者（≥40岁）术后8周出现声学和空气动力学变化，尽管他们报告无嗓音异常且其感知评估与术前相似。
