Department of Otorhinolaryngology-Head & Neck Surgery, Kuopio University Hospital, PL 100, 70029 Kuopio, Finland Institute of Clinical Medicine, University of Eastern, Kuopio, Finland.
Department of Otorhinolaryngology-Head & Neck Surgery, Kuopio University Hospital, Kuopio, Finland Institute of Clinical Medicine, University of Eastern, Kuopio, Finland.
Scand J Surg. 2021 Dec;110(4):524-532. doi: 10.1177/14574969211007036. Epub 2021 Apr 12.
The aim of this study was to evaluate the utility of two items in vocal fold paresis and paralysis screening after thyroid and parathyroid surgery: patient self-assessment of voice using the Voice Handicap Index and computer-based acoustic voice analysis using the Multi-Dimensional Voice Program.
This was a prospective study of 181 patients who underwent thyroid or parathyroid surgery over a 1-year study period (2017). Preoperatively, all patients underwent laryngoscopic vocal fold inspection and acoustic voice analysis, and they completed the Voice Handicap Index questionnaire. Postoperatively, all patients underwent laryngoscopy prior to hospital discharge; 2 weeks after the surgery, they completed the Voice Handicap Index questionnaire a second time. Two weeks postoperatively, patients with vocal fold paresis or paralysis and 20 randomly selected controls without vocal fold paresis or paralysis underwent a follow-up acoustic voice analysis.
Fourteen patients had a new postoperative vocal fold paresis or paralysis. Postoperatively, the total Voice Handicap Index score was significantly higher (p = 0.040) and the change between preoperative and postoperative scores was greater (p = 0.028) in vocal fold paresis or paralysis patients. A total postoperative Voice Handicap Index score > 30 had 55% sensitivity, and 90% specificity, for vocal fold paresis or paralysis. In the postoperative Multi-Dimensional Voice Program analysis, vocal fold paresis or paralysis patients had significantly more jitter (p = 0.044). Postoperative jitter > 1.33 corresponded to 55% sensitivity, and 95% specificity, for vocal fold paresis or paralysis.
In identifying postoperative vocal fold paresis or paralysis, patient self-assessment and jitter in acoustic voice analysis have high specificity but poor sensitivity. Without routine laryngoscopy, approximately half of the patients with postoperative vocal fold paresis or paralysis could be overlooked. However, if the patient has no complaints of voice disturbance 2 weeks after thyroid or parathyroid surgery, the likelihood of vocal fold paresis or paralysis is low.
本研究旨在评估声带麻痹和瘫痪筛查中的两个项目在甲状腺和甲状旁腺手术后的效用：患者使用语音障碍指数（Voice Handicap Index）进行自我评估和使用多维语音程序（Multi-Dimensional Voice Program）进行计算机声学分折。
这是一项为期 1 年（2017 年）的前瞻性研究，共纳入 181 例接受甲状腺或甲状旁腺手术的患者。术前所有患者均接受喉镜声带检查和声学分折，并完成语音障碍指数问卷。术后所有患者在出院前进行喉镜检查；术后 2 周，他们第二次完成语音障碍指数问卷。术后 2 周，声带麻痹或瘫痪的患者和 20 名随机选择的无声带麻痹或瘫痪的对照组患者进行了随访声学分折。
14 例患者术后新发声带麻痹或瘫痪。术后，声带麻痹或瘫痪患者的总语音障碍指数评分显著升高（p=0.040），术前和术后评分的变化更大（p=0.028）。术后总语音障碍指数评分>30 分对声带麻痹或瘫痪的敏感性为 55%，特异性为 90%。在术后多维语音程序分折中，声带麻痹或瘫痪患者的抖动显著增加（p=0.044）。术后抖动>1.33 对应声带麻痹或瘫痪的敏感性为 55%，特异性为 95%。
在识别术后声带麻痹或瘫痪方面，患者自我评估和声学分折中的抖动具有高特异性但低敏感性。如果没有常规喉镜检查，大约一半的术后声带麻痹或瘫痪患者可能会被忽略。但是，如果患者在甲状腺或甲状旁腺手术后 2 周没有声音障碍的抱怨，声带麻痹或瘫痪的可能性较低。
