How Can We Predict the Recovery from Pitch Lowering After Thyroidectomy?
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ORIGINAL SCIENTIFIC REPORT
How Can We Predict the Recovery from Pitch Lowering After Thyroidectomy? Sang-Yeon Kim1 • Jun-Ook Park2 • Ja-Seong Bae3 • So-Hee Lee3 • Yeon-Shin Hwang2 Mi-Ran Shim2 • Young-Hak Park2 • Dong-Il Sun2
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Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background Some of patients are suffered from pitch lowering of voice after thyroidectomy. We sought to identify factors predictive of a recovery from lowered pitch voice after thyroid surgery. Methods We retrospectively reviewed the records of 133 patients who underwent total thyroidectomy to treat papillary carcinoma between January 2012 and February 2013. Of these, we enrolled 78 who exhibited a lowerpitched voice (SFF fall [ 12 Hz) at 2 weeks post-operatively than pre-operatively and investigated pitch recovery after 3 months. We subclassified patients into recovery and non-recovery groups and compared videostroboscopic findings, acoustic voice data, and thyroidectomy-related voice questionnaire scores pre-operatively and 2, 8, and 12 weeks post-operatively. Results Vocal cord asymmetry on videostroboscopic examination at 2 weeks post-operatively (odds ratio 19.056, p = 0.001*) was more frequent in the non-recovery group. In acoustic analysis, mean pre-operative SFF was higher in the non-recovery group than the recovery group (190.9 ± 27.5 and 180.9 ± 24.6 Hz, respectively; p = 0.030*). Also, a reduction in the SFF of [ 19.6 Hz, at 2 weeks post-operatively versus pre-operatively, predicted nonrecovery of pitch-lowering in patients with reduced SFF within post-operative 3 months, with 72.0% sensitivity and 71.2% specificity. After 6 months of follow-up, no patient who exhibited an SFF fall [ 19.6 Hz recovered to within 10 Hz of the pre-operative value. Conclusion A reduction in the speaking fundamental frequency (SFF) [ 19.6 Hz at 2 weeks post-operatively predicted persisting lowering of voice pitch after thyroidectomy among those with lower-pitched voices after surgery. Pre-operative high SFF and post-operative stroboscopic findings including vocal cord asymmetry at 2 weeks postoperatively also predicted persisting lowering of voice pitch for 3 months.
Introduction & Dong-Il Sun [email protected] 1
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Inje University of Korea, Busan, Republic of Korea
2
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
3
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Voice problems after thyroid surgery are well-known and may be temporary or permanent. Early detection and management can improve patient outcomes and quality-oflife [1]. Recurrent laryngeal nerve (RLN) injury has been considered to be one of the main causes of voice change after thyroidectomy; the incidence is 0.3–15.4% [2]. However, many other factors also contribute to voice change, including injury to the external branch of the superior laryngeal nerve (EBSLN), c
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