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One of the common adverse effects following thyroid surgery is a change in voice, which may be related to iatrogenic injury to the recurrent laryngeal nerve or superior laryngeal nerve during surgery or by direct cancer involvement. The burden of persistent voice changes in long-term follow-up is not well described. Voice changes following thyroid surgery are likely under-recognised, at least in part owing to rare use of validated scales to assess the outcome of thyroid surgery on voice and in the differential use of routine preoperative and postoperative laryngoscopy examination. This investigation was designed as a population-based survey to assess voice outcomes following surgery using VHI-10 questionnaire responses. A total of 2325 patients who had surgery for well-differentiated thyroid cancer were included. Of these, 272 patients (12.7%) were identified as having an abnormal VHI-10 score, and 105 patients (4.7%) had vocal fold motion impairment diagnosed by laryngoscopy. Abnormal VHI-10 score had significant associations with age group 45 to 54 years, black race, Asian race, reflux disease and surgical extent including lateral neck dissection. The high prevalence of patient-reported voice problems and identification of risk factors for poor voice outcomes in this study highlight the need for awareness of voice abnormalities following surgery. Anticipated voice outcomes warrant consideration in the preoperative risk-benefit discussion, planned extent of surgery, and postoperative rehabilitation.

Assessment of Voice Outcomes Following Surgery for Thyroid Cancer.
Kovatch KJ, Reyes-Gastelum D, Hughes DT, et al.
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Shabbir Akhtar

Department of Surgery, The Aga Khan University and Hospital, Karachi, Pakistan.

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