Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid
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ORIGINAL SCIENTIFIC REPORT
Perceptual Assessment and Acoustic Voice Analysis as Screening Tests for Vocal Fold Paresis After Thyroid or Parathyroid Surgery Maria Heikkinen1,2 • Elina Penttila¨1,2 • Mari Qvarnstro¨m3 • Kimmo Ma¨kinen2,4 Heikki Lo¨ppo¨nen1,2 • Jussi M. Ka¨rkka¨inen4
•
Accepted: 7 November 2020 Ó The Author(s) 2020
Abstract Background The aim of this study was to evaluate the reliability of clinician-based perceptual assessment of voice and computerized acoustic voice analysis as screening tests for vocal fold paresis or paralysis (VFP) after thyroid and parathyroid surgery. Methods This was a prospective study of 181 patients undergoing thyroid or parathyroid procedure with pre and postoperative laryngoscopic vocal fold inspection, perceptual voice assessment using grade, roughness, breathiness, asthenia, and strain (GRBAS) scale and acoustic voice analysis using the multi-dimensional voice program (MDVP). Patients were divided into 2 groups for comparison; those with new postoperative VFP and those without. Potential screening tools were evaluated using the receiving operating characteristic (ROC) analysis. Results Fourteen (6.6%) patients had a new postoperative VFP. Postoperative GRBAS scores were significantly (P \ 0.05) higher in patients with VFP compared to those without. However, there were no statistically significant differences in MDVP values between the groups. Postoperative GRBAS grade score (cut off [ 0) had the best sensitivity, 93%, for predicting VFP, but the specificity was only 50%. Postoperative jitter (cut off [ 1.60) in MDVP had a good specificity, 90%, but only 50% sensitivity. Combining all the GRBAS and MDVP variables with P \ 0.05 in the ROC analysis yielded a test with 100% sensitivity and 55% specificity. Conclusions Physician-based perceptual voice assessment has a high sensitivity for detecting postoperative VFP, but the specificity is poor. The risk of VFP is low in patients with completely normal voice at discharge. However, routine laryngoscopy after thyroid and parathyroid surgery is still the most reliable exam for VFP screening.
Introduction
& Maria Heikkinen [email protected] 1
Department of Otorhinolaryngology – Head & Neck Surgery, Kuopio University Hospital, PL 100, 70029 Kuopio, Finland
2
Institute of Clinical Medicine, University of Eastern, Kuopio, Finland
3
Department of Phoniatrics, Kuopio University Hospital, Kuopio, Finland
4
Heart Center, Kuopio University Hospital, Kuopio, Finland
Vocal fold paresis or paralysis (VFP) caused by recurrent laryngeal nerve injury is a well-known complication following thyroid or parathyroid surgery with incidence rates ranging from 1.4% to 38% (1–4). In most institutions, the risk of postoperative VFP is roughly 5% [1, 3–10]. Postoperatively, VFP can be asymptomatic and go undetected unless routine laryngoscopy examinations are performed [11, 12]. The postoperative assessment of vocal fold function with laryngoscopy is time-consuming, requires special equipment and may cause discomfort to the patient. Sti
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