Postoperative vocal fold dysfunction in covid-19 era: are we still in time for a recovery?
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LETTER TO THE EDITOR
Postoperative vocal fold dysfunction in covid-19 era: are we still in time for a recovery? Elena Bonati
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Elena Giovanna Bignami2 Paolo Del Rio1 ●
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Received: 14 May 2020 / Accepted: 21 July 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
To the Editor: The novel 2019 coronavirus (COVID-19) is a highly contagious zoonosis produced by SARS-CoV-2, which arose in China and spread all over the world, transmitting from man to man through respiratory secretions. In March 2020, it was defined by the World Health Organization (WHO) as a pandemic, to underline its spread and severity. Healthcare professionals are one of the categories most at risk of contracting the infection, in particular when their activity involves the direct management of the patient’s airways. Among these categories, we can count anesthetists, head and neck surgeons, otolaryngologists, maxillofacial surgeons, ophthalmologists, and dentists. For these reasons, the latest evidence-based recommendations for otolaryngology and head and neck surgery practice suggest that healthcare facilities should prioritize urgent and emergency visits and procedures until this condition stabilizes, ceasing elective care [1]. Nevertheless, oncological surgical activity, although slowed down, did not stop in most hub hospitals. Regarding thyroid cancer, thyroid surgery is complex and the rate of nerve damage is still considerable. Immediate postoperative vocal fold rate is 2–4% in our case study, and decrease to 1–2% after 6 months. Postoperative dysphonia can be caused by several factors other than nerve damage, such as tracheal intubation or scarring in the thyroid lodge. It is, therefore, important to identify the cause of vocal cord dysfunction and treat it correctly, at the right time. If an unilateral vocal fold paresis/paralysis is diagnosed, the treatment consist in improving the speech, while, in case of
* Elena Bonati [email protected] 1
General Surgery Unit, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
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Unit of Anesthesiology, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
bilateral vocal fold paresis/paralysis, respiratory obstruction also needs to be urgently treated. Fortunately, we have brought the incidence of this last and most dangerous complication to 0% at our Clinic, since the introduction in 2014 of the routine use of intraoperative neuromonitoring during thyroidectomy. The latest guidelines published by the American Association of Endocrine Surgeons in March 2020 recommend laryngeal examination in patients with known or suspected new recurrent laryngeal nerve dysfunction after thyroidectomy, for additional evaluation and possible treatment with a speech pathologist. According to the American Academy of Otolaryngology—Head and Neck Surgery, they assert that early referral (2–8 weeks post surgery) to a laryngologist, in combination with early intervention, results in superior voice outcomes, since th
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