甲状腺切除术后声带未麻痹的嗓音变化：2297 例甲状腺切除术患者的分析。

Voice change after thyroidectomy without vocal cord paralysis: Analysis of 2,297 thyroidectomy patients.

机构信息

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Inje University of Korea, Busan, Republic of Korea.

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Surgery. 2020 Dec;168(6):1086-1094. doi: 10.1016/j.surg.2020.07.055. Epub 2020 Sep 10.

DOI:10.1016/j.surg.2020.07.055

PMID:32919781

Abstract

BACKGROUND

Some patients experience long-term voice change after thyroidectomy. One of the most common symptoms of voice change is pitch lowering, which is closely related to unfavorable voice quality. Here we observed voice outcomes for 6 months of follow-up after thyroidectomy to identify factors closely related to low-pitched voice.

METHODS

We retrospectively reviewed the records of 2,297 patients who underwent thyroidectomy between January 2014 and December 2017. All the patients had their vocal status examined using videostroboscopy, acoustic voice analyses, aerodynamic study, and Thyroidectomy-Related Voice Questionnaire scores. We stratified patients into 2 groups (low-pitched voice versus favorable voice) according to pitch lowering (reduction in speaking fundamental frequency ≥12 Hz 1 month after thyroidectomy compared to the preoperative value). We compared preoperative data with postoperative data collected 1, 3, and 6 months after thyroidectomy to identify factors contributing to low-pitched voice.

RESULTS

Univariate logistic regression analyses showed that factors related to low-pitched voice were female sex, older age, low body weight, short stature, and a high positive lymph node ratio. Multivariate analyses showed that female sex and older age were significantly associated with a negative prognosis for low-pitched voice 1 month after thyroidectomy (odds ratios 0.41 and 1.04, respectively; P < .001). Receiver operating characteristic curves for predicting sustained low-pitched voice during 6 months showed that speaking fundamental frequency ≥12.48 Hz 1 month after thyroidectomy was the optimal cutoff value, with 87.9% sensitivity and 95.8% specificity (P < .001).

CONCLUSION

Female sex and older age are strongly associated with increased risk for low-pitched voice after thyroidectomy. Speaking fundamental frequency ≥12.48 Hz 1 month after thyroidectomy can be used to predict sustained low-pitched voice after thyroidectomy.

摘要

背景

一些甲状腺手术后的患者会长期出现声音改变。声音改变最常见的症状之一是音调降低，这与不良的音质密切相关。在此，我们观察了甲状腺切除术后 6 个月的随访结果，以确定与低声调密切相关的因素。

方法

我们回顾性分析了 2014 年 1 月至 2017 年 12 月期间接受甲状腺切除术的 2297 例患者的病历。所有患者均采用频闪喉镜、声学嗓音分析、空气动力学研究和甲状腺切除术相关嗓音问卷评分检查嗓音状况。我们根据音调降低（与术前相比，术后 1 个月时发音基频降低≥12 Hz）将患者分为 2 组（低声调组和正常声组）。我们比较了术前数据与术后 1、3 和 6 个月的数据，以确定导致低声调的因素。

结果

单因素逻辑回归分析显示，与低声调相关的因素为女性、年龄较大、体重较轻、身材矮小和高阳性淋巴结比例。多因素分析显示，女性和年龄较大与甲状腺切除术后 1 个月低声调预后不良显著相关（比值比分别为 0.41 和 1.04；P＜0.001）。预测 6 个月持续低声调的受试者工作特征曲线显示，术后 1 个月发音基频≥12.48 Hz 是最佳截断值，具有 87.9%的敏感性和 95.8%的特异性（P＜0.001）。