Kovatch Kevin J, Reyes-Gastelum David, Hughes David T, Hamilton Ann S, Ward Kevin C, Haymart Megan R
Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor.
Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor.
JAMA Otolaryngol Head Neck Surg. 2019 Sep 1;145(9):823-829. doi: 10.1001/jamaoto.2019.1737.
An increasing number of surgeries are being performed for differentiated thyroid cancer (DTC). Long-term voice abnormalities are a known risk of thyroid surgery; however, few studies have used validated scales to quantify voice outcomes after surgery.
To identify the prevalence, severity, and factors associated with poor voice outcomes following surgery for DTC.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, population-based survey was distributed via a modified Dillman method to 4185 eligible patients and linked to Surveillance, Epidemiology and End Results (SEER) data from SEER sites in Georgia and Los Angeles, California, from February 1, 2017, to October 31, 2018. Multivariable logistic regression and zero-inflated negative binomial analysis were performed to determine factors associated with abnormal voice. Participants included patients undergoing surgery for DTC between January 1, 2014, and December 31, 2015, excluding those with voice abnormalities before surgery.
Abnormal Voice Handicap Index (VHI-10) score, defined as greater than 11. The VHI-10 is designed to quantify 10 psychosocial consequences of voice disorders on a Likert scale (0, never; to 4, always).
A total of 2632 patients (63%) responded to the survey and 2325 met the inclusion criteria. With data reported as unweighted number and weighted percentage, 1792 were women (77.4%); weighted mean (SD) age was 49.4 (14.4) years. Of these, 599 patients (25.8%) reported voice changes lasting more than 3 months following surgery, 272 patients (12.7%) were identified as having an abnormal VHI-10 score, and 105 patients (4.7%) reported vocal fold motion impairment diagnosed by laryngoscopy. In multivariable analysis, factors associated with an abnormal VHI-10 score included age 45 to 54 years (reference, ≤44 years; odds ratio [OR], 1.49; 95% CI, 1.05-2.11), black race (OR, 1.73; 95% CI, 1.14-2.62), Asian race (OR, 1.66; 95% CI, 1.08-2.54), gastroesophageal reflux disease (OR, 1.67; 95% CI, 1.15-2.43), and lateral neck dissection (OR, 1.99; 95% CI, 1.11-3.56).
A high prevalence of abnormal voice per validation with the VHI-10 emphasizes the need for heightened awareness of voice abnormalities following surgery and warrants consideration in the preoperative risk-benefit discussion, planned extent of surgery, and postoperative rehabilitation.
越来越多的手术用于治疗分化型甲状腺癌（DTC）。长期声音异常是甲状腺手术已知的风险；然而，很少有研究使用经过验证的量表来量化术后的声音结果。
确定DTC手术后声音结果不佳的患病率、严重程度及相关因素。
设计、设置和参与者：通过改良的迪尔曼方法对4185名符合条件的患者进行了一项基于人群的横断面调查，并与2017年2月1日至2018年10月31日来自佐治亚州和加利福尼亚州洛杉矶的监测、流行病学和最终结果（SEER）数据相链接。进行多变量逻辑回归和零膨胀负二项式分析以确定与声音异常相关的因素。参与者包括2014年1月1日至2015年12月31日期间接受DTC手术的患者，不包括术前有声音异常的患者。
异常嗓音障碍指数（VHI-10）评分，定义为大于11。VHI-10旨在通过李克特量表（0，从不；至4，总是）量化嗓音障碍的10种心理社会后果。
共有2632名患者（63%）回复了调查，2325名符合纳入标准。数据以未加权数字和加权百分比报告，1792名是女性（77.4%）；加权平均（标准差）年龄为49.4（14.4）岁。其中，599名患者（25.8%）报告术后声音变化持续超过3个月，272名患者（12.7%）被确定VHI-10评分异常，105名患者（4.7%）报告经喉镜检查诊断为声带运动障碍。在多变量分析中，与VHI-10评分异常相关的因素包括45至54岁（参照，≤44岁；比值比[OR]，1.49；95%置信区间，1.05-2.11）、黑人种族（OR，1.73；95%置信区间，1.14-2.62）、亚洲种族（OR，1.66；95%置信区间，1.08-2.54）、胃食管反流病（OR，1.67；95%置信区间，1.15-2.43）和侧颈清扫术（OR，1.99；95%置信区间，1.11-3.56）。
经VHI-10验证的异常嗓音高患病率强调了术后对声音异常需提高认识，并在术前风险效益讨论、手术计划范围和术后康复中值得考虑。
