Beka Ervin, Gimm Oliver
Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden.
Department of Surgery and Department of Biomedical and Clinical Sciences, Linköping University, 58183 Linköping, Sweden.
J Voice. 2024 Jan;38(1):231-238. doi: 10.1016/j.jvoice.2021.07.012. Epub 2021 Aug 14.
Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat.
The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves.
While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment.
甲状腺切除术是一种常见的外科手术，用于治疗不同的甲状腺疾病。全甲状腺切除术后最常见的并发症是短暂性或永久性甲状旁腺功能减退，其次是短暂性或永久性喉返神经麻痹。尽管喉神经功能完好，患者仍可能出现声音障碍。这些患者备受关注，因为他们经历的主观症状难以测量，因此也难以治疗。
嗓音障碍指数（VHI）和VHI-10是最常用的主观问卷。其结果与客观检查结果相关。女性，尤其是绝经后女性，是甲状腺切除术后发生声音障碍的主要因素。颈部手术的范围以及切除甲状腺的重量和体积与术后客观和主观声音障碍直接相关。对于该患者群体，应考虑采用电子喉镜频闪喉镜检查来评估声带病变。令人惊讶的是，尚无研究表明言语和嗓音治疗对喉神经完好但有声音改变的患者有益。
虽然术后可通过客观检查评估喉返神经（RLN）麻痹，但我们仍面临可能存在的喉上神经外支（EBSLN）部分或完全损伤问题。因此，无论采用何种文献评估方法，都很难区分神经源性（RLN和EBSLN）和非神经源性声音改变人群。或许在决定哪些患者应进一步接受喉镜检查、声学或感知分析以及哪些患者应接受治疗时，患者对自身声音功能体验的看法应发挥更重要的作用。
