Abstract
Background
Iatrogenic unilateral vocal fold paralysis caused by thyroid surgery induces profound
physical and psychosocial distress in patients. The natural course of functional recovery
over time differs substantially across subjects, but the mechanisms underlying this
difference remain unclear. In this study, we examined whether the anatomic site of
the lesion affected the trajectory of recovery.
Methods
In this prospective case series study in a single medical center, patients with thyroid
surgery–related unilateral vocal fold paralysis were evaluated using quantitative
laryngeal electromyography, videolaryngostroboscopy, voice acoustic analysis, the
Voice Outcome Survey, and the Short Form-36 quality-of-life questionnaire. Patients
with and without superior laryngeal nerve injuries were compared.
Results
Forty-two patients were recruited, among whom 15 and 27 were assigned to the with
and without superior laryngeal nerve injury groups, respectively. Compared with the
group without superior laryngeal nerve injury, the group with superior laryngeal nerve
injury group demonstrated less improvement in the recruitment of vocal fold adductors,
and the group also had more severe impairment of vocal fold vibration, maximum phonation
time, jitter, shimmer, and harmony-to-noise ratio at the first evaluation. This difference
was also found in the glottal gap and maximum phonation time 12 months after the injury.
Conclusion
Among patients with thyroid surgery–related unilateral vocal fold paralysis, superior
laryngeal nerve injury induces a distinctively different recovery trajectory compared
with those without superior laryngeal nerve injury characterized by less reinnervation
of vocal fold adductors and worse presentation in terms of the glottal gap and maximum
phonation time. This study emphasizes the importance of superior laryngeal nerve function
and its preservation in thyroid surgery.
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Article info
Publication history
Published online: June 27, 2020
Accepted:
April 20,
2020
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
