Whilst intraoperative nerve monitoring has become the standard of care for mastoid and parotid surgery, its benefit in thyroid surgery remains unclear. In the UK NICE was agnostic on the subject in 2008, stating that it was potentially helpful and a teaching aid whilst maintaining the caveat that it may give surgeons a false sense of security. This study looked at 68 female patients undergoing thyroidectomy for papillary thyroid carcinoma using intraoperative neuromonitoring (IONM). This was compared with a historical group of 117 patients who did not have IONM. Very detailed voice analysis was performed preop, one week, one month and three months after surgery. The results show that voice changes were significantly smaller in the IONM group at one week and one month. These changes weren’t present at three months. The voice analysis was very thorough and clearly demonstrates that subtle voice change is common after thyroid surgery but is usually transient. A confounding factor may have been experience of the operating surgeon in each group. In the end, a commendable effort to try and answer the question of the merits of intraoperative nerve monitoring in thyroid surgery. Probably encouragement for fans and sceptics alike. It seems to have some impact in terms of the immediate postoperative voice which would imply some degree of nerve protection. That said the long-term outcome seems unchanged.

Efficiency of intraoperative neuromonitoring on voice outcomes after thyroid surgery.
Baek S-K, Lee K , Oh D, et al.
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Ravi Thevasagayam

Clinical Lead, Department of ENT, Sheffield Children’s Hospital, Sheffield, S10 2TH, UK.

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