Volume 15, Issue 4 (December 2017)                   Iranian Rehabilitation Journal 2017, 15(4): 399-406 | Back to browse issues page

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Junuzovic Zunic L, Ibrahimagic A, Altumbabic S, Umihanic S, Izic B. Improving Voice Outcomes After Injury to the Recurrent Laryngeal Nerve. Iranian Rehabilitation Journal 2017; 15 (4) :399-406
URL: http://irj.uswr.ac.ir/article-1-784-en.html
Improving Voice Outcomes After Injury to the Recurrent Laryngeal Nerve
Lejla Junuzovic Zunic * 1, Amela Ibrahimagic1 , Selma Altumbabic2 , Sekib Umihanic1 , Belkisa Izic3
1- Department of Speech Therapy and Rehabilitative Audiology, Faculty for Special Education and Rehabilitation, University of Tuzla, Tuzla, Bosnia and Herzegovina.
2- Department of Audiology and Phoniatrics, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
3- Clinic for Radiology and Nuclear Medicine, University Clinical Center Tuzla, Bosnia and Herzegovina.
Abstract:   (5740 Views)
Objectives: The present study aimed to determine the voice outcomes before and after the administration of voice therapy in patients who suffered an injury to the recurrent laryngeal nerve after undergoing thyroidectomy.
Methods: The sample consisted of 26 patients (2 males and 24 females) aged between 18 and 80 years (m=55±12) who experienced injury to the recurrent laryngeal nerve following thyroidectomy that was used to treat a thyroid gland disease. Subjective and objective parameters of the voice of the patients as well as its aerodynamic aspects were assessed upon the completion of the surgical procedure and before and after the implementation of voice therapy. Objective voice analysis was performed with the help of computer software viz. “Speech Training for Windows, Version 4.00 - Dr. Speech “and” EZ Voice Plus (TM) v. 2.0;” while GRBAS scale was used for subjective voice assessment. The subjects were followed for two years. The data so collected during this period was analyzed by implementing descriptive statistical parameters, Chi-square test, t-test and Wilcoxon test.
Results: Patients with an injury to the recurrent laryngeal nerve were found to have voice alterations in all vocal parameters of subjective voice assessment conducted using the GRBAS Scale. These alterations ranged from moderate to severe degree, which provided a high degree of roughness in the voice. Objective voice assessment parameter analysis showed a decrease in voice pitch, increase in shimmer, decrease in noise-to-harmonics ratio, decrease in maximum phonation time and a decrease in voiceless percentage. Overall, it was observed that there were significant differences in all parameters of subjective and objective voice assessment, before and after vocal therapy, except for variables regarding the noise-to-harmonics ratio and aerodynamic variable of the S/Z ratio, although, the results on these vocal parameters were better after voice therapy.
Discussion: Laryngeal symptoms are known to often accompany thyroidectomy procedures. In the present study, it was observed that administration of vocal therapy and teamwork between the doctors and speech therapist significantly affected the patient’s recovery and improvement in the quality of voice after thyroidectomy.
Keywords: Thyroidectomy, Recurrent laryngeal nerve, Voice symptoms, Voice therapy
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Article type: Original Research Articles | Subject: Speech therapy
Received: 2007/07/22 | Accepted: 2017/10/20 | Published: 2017/12/1
References
1. Tunbridge WMG, Evered DC, Hall R, Appleton D, Brewis M, Clark F, et al. The spectrum of thyroid disease in a community: The whickham survey. Clinical Endocrinology. 1977; 7(6):481–93. doi: 10.1111/j.1365-2265.1977.tb01340.x [DOI]
2. Dodig K, Kusić Z. Klinička nuklearna medicina. Zagreb: Medicinska Naklada; 2012.
3. Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier Kraemar J, et al. Clinical practice guideline: Improving voice outcomes after thyroid surgery. Otolaryngology–Head and Neck Surgery. 2013; 148 (6S):1-37. doi: 10.1177/0194599813487301 [DOI]
4. Zábrodský M, Chovanec M, Fik Z, Bouček J, Betka J. Changes of VKG picture and objective voice analysis in the application of minimal invasive technologies and NM in thyroid gland surgery. Otorhinolaryngology and Phoniatrics. 2012; 61(3): 148-161.
5. Souza SL, Crespo A, Alves de Medeiros JL. Laryngeal vocal and endoscopic alterations after thyroidectomy under local anesthesia and hypnosedation. Brazilian Journal of Otorhinolaryngology. 2009; 75(4):511-516. doi: 10.1016/S1808-8694(15)30489-4 [DOI]
6. Yeung P, Erskine C, Mathewes P, Crowe, PJ. Voice changes and thyroid surgery: Is pre-operative indirect laryngoscopy necessary. The Australian and New Zealand Journal of Surgery. 1999; 69(9):632-4. doi: 10.1046/j.1440-1622.1999.01653.x [DOI]
7. Sanabria A, Silver CE, Suárez C, Shaha A, Khafif A, Owen RP et al. Neuromonitoring of the laryngeal nerves in thyroid surgery: A critical appraisal of the literature. European Archives of Oto-Rhino-Laryngology. 2013; 270(9):2383-95. doi: 10.1007/s00405-013-2558-1 [DOI]
8. Aluffi P, Policarpo M, Cherovac C, Olina M, Dosdegani R, Pia F. Post thyroidectomy superior laryngeal nerve injury. European Archives of Oto-Rhino-Laryngology. 2001; 258(9):451-4. doi: 10.1007/s004050100382 [DOI]
9. Sakorafas GH, Kokoropoulos P, Lappas C, Sampanis D, Smyrniotis V. External branch of the superior laryngeal nerve: Applied surgical anatomy and implications in thyroid surgery. The American Surgeon. 2012; 78(9):986-91. PMID: 22964209 [PubMed]
10. Andrews ML. Manual of Voice Treatment: Pediatrics through Geriatrics. Canada: Thomson Delmar Learning ; 2006.
11. Stojadinovic A, Shaha AR, Orlikoff RF, Nissan A, Kornak MF, Singh B et al. Prospective functional voice assessment in patients undergoing thyroid surgery. Annals of Surgery. 2002; 236(6):823-32. PMCID: PMC1422649 [PubMed]
12. Neri G, Castiello F, Vitullo F, De Rosa M, Ciammetti G, Croce A. Post thyroidectomy dysphonia in patients with bilateral resection of the superior laryngeal nerve: A comparative spectrographic study. Acta Otorhinolaryngol Italica. 2011; 31(4):228-34. PMCID: PMC3203714 [PubMed]
13. Jeannon JP, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: A systematic review. International Journal of Clinical Practice. 2009; 63(4):624-9. doi: 10.1111/j.1742-1241.2008.01875.x [DOI]
14. de Morais Costa EB, de Araujo Pernambuco L. Vocal self-assessment and auditory and auditory perceptual assessment of voice in women with thyroid disease. Revista Cefac. 2014; 16(3):967-72. doi: 10.1590/1982-021620145913 [DOI]
15. Lombardi CP, Raffaelli M, D'Alatri L, Marchese MR, Rigante M, Paludetti G et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006; 140(6):1026-34. doi: 10.1016/j.surg.2006.08.008 [DOI]
16. Aronson AE. Clinical voice disorders: An interdisciplinary Approach. New York: Thieme Inc.; 1980.
17. Hirano M. Psycho acoustic evaluation of voice. In: Hirano M, editor. Clinical examination of the voice. New York: Springer; 1981.
18. Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Archives of Otolaryngology. 2002; 128: 389-92. doi: 10.1001/archotol.128.4.389 [DOI]
19. McIvor NP, Flint DJ, Gillibrand J, Morton RP. Thyroid surgery and voice related outcomes. The Australian and New Zealand Journal of Surgery. 2000; 70(3):179-83. doi: 10.1046/j.1440-1622.2000.01781.x [DOI]
20. Akyildiz S, Ogut F, Akyildiz M, Engin EZ. A multivariate analysis of objective voice changes after thyroidectomy without laryngeal nerve injury. Archives of Otolaryngology. 2008; 134(6):596-602. doi: 10.1001/archotol.134.6.596 [DOI]
21. Hong KH, Kim YK. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngology–Head and Neck Surgery. 1997; 117(4):399–404. doi: 10.1016/S0194-5998(97)70133-5 [DOI]
22. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World Journal of Surgery. 2008; 32(7):1358–66. doi: 10.1007/s00268-008-9483-2 [DOI]
23. Rubin AD, Sataloff RT. Vocal fold paresis and paralysis. Otolaryngologic Clinics of North America. 2007; 40(5):1109-31. doi: 10.1016/j.otc.2007.05.012 [DOI]
24. Mattioli F, Bergamini G, Alicandri Ciufelli M, Molteni M, Luppi MP, Nizzoli F, et al. The role of early voice therapy in the incidence of motility recovery in unilateral vocal fold paralysis. Logopedics, Phoniatrics, Vocology. 2011; 36(1):40-7. doi: 10.3109/14015439.2011.554433 [DOI]
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