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      The Effect of Total Thyroidectomy on the Speech Production

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          Abstract

          Objectives

          Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury.

          Methods

          Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods.

          Results

          SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery.

          Conclusion

          Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.

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          Most cited references21

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          Prospective functional voice assessment in patients undergoing thyroid surgery.

          To analyze voice function before and after thyroidectomy for patients with normal preoperative voice using a standardized multidimensional voice assessment protocol. The natural history of post-thyroidectomy voice disturbances for patients with preserved laryngeal nerve function has not been systematically studied and characterized with the intent of using the data for postoperative voice rehabilitation. During a prospective single-arm study, patients with normal voice underwent functional voice testing using a standardized voice grading scale and a battery of acoustic, aerodynamic, glottographic, and videostroboscopic tests before, 1 week after, and 3 months after thyroidectomy. Differences in observed sample means were evaluated using analysis of covariance or t test; categorical data was analyzed using the Fisher exact or chi-square test. Fifty-four patients were enrolled; 50 and 46 were evaluable at 1 week and 3 months, respectively. No patient developed recurrent laryngeal nerve injury; one had superior laryngeal nerve injury. Fifteen (30%) patients reported early subjective voice change and seven (14%) reported late (3-month) subjective voice change. Forty-two (84%) patients had significant objective change in at least one voice parameter. Six (12%) had significant alterations in more than three voice measures, of which four (67%) were symptomatic, whereas 25% with three or fewer objective changes had symptoms. Patients with persistent voice change at 3 months had an increased likelihood of multiple (more than three) early objective changes (43% vs. 7%). Early maximum phonational frequency range and vocal jitter changes from baseline were significantly associated with voice symptoms at 3 months. Early vocal symptoms are common following thyroidectomy and persist in 14% of patients. Multiple (more than three) objective voice changes correlate with early and late postoperative symptoms. Alterations in maximum phonational frequency range and vocal jitter predict late perceived vocal changes. Factors other than laryngeal nerve injury appear to alter post-thyroidectomy voice. The variability of patient symptoms underscores the importance of understanding the physiology of dysphonia.
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            Voice changes after thyroidectomy without recurrent laryngeal nerve injury.

            Injury of the inferior laryngeal nerve is not the only cause of voice alteration after thyroidectomy; many patients notice minimal changes immediately after operation, without evidence of inferior laryngeal nerve damage. We hypothesized that there may be other causes for voice modification, such as injuries of the superior laryngeal nerve, prethyroid strap muscles, and cricothyroid muscles. We describe voice changes after total thyroidectomy, without inferior laryngeal nerve injury, using a computer program to objectively compare different patterns of voice. Forty-six consecutive patients who underwent total thyroidectomy were studied between March 1997 and December 1999. Acoustic voice analysis was performed preoperatively and at the second, fourth, and sixth postoperative months using a microphone adapted to a personal computer. Parameters measured were intensity of the voice (Shimmer) and fundamental frequency (Fo). No complications occurred during operation or in the postoperative period. Voice fatigue during phonation was the most common symptom after thyroidectomy. Forty patients (87%) stated that their voices had changed since the operation, and common complaints were voice alteration while speaking loudly, changes in voice pitch, and voice disorder while singing. Changes in the Fo and Shimmer values in smokers versus nonsmokers were similar (Fo overall, p = 0.56; Shimmer overall, p = 0.66), as were the same parameters in benign and malignant pathologies (Fo overall, p = 0.66; Shimmer overall, p = 0.67). Voice changes after uncomplicated thyroidectomy occur and can be objectively measured. This is important in the preoperative counseling of patients before thyroidectomy, for ethical and legal purposes.
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              Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury.

              Complications that arise after thyroid surgery may be associated with infection, hemorrhage, hormonal problems, and laryngeal nerve injury. Voice alteration after thyroidectomy is usually caused by recurrent or superior laryngeal nerve injury. This voice dysfunction may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. In this study, we evaluated the voice function phonetically before and after thyroidectomy in 54 patients, although function of the recurrent and superior laryngeal nerves was normal. During surgery, the superior and recurrent laryngeal nerves were identified and protected, and after surgery electromyographic testing of the cricothyroid muscle was performed. Typical voice symptoms after surgery were easy fatigue during phonation and difficulty with high pitch and singing voice. Acoustic analysis revealed that the phonation time and fundamental frequency were not changed after surgery, but the speaking fundamental frequency, range of speaking fundamental frequency, and vocal range were significantly diminished after surgery. These data allowed us to suggest that the cause of voice dysfunction is not seen in neural lesions, but in a disturbance of the extralaryngeal skeleton. These voice changes emphasize the importance of the extralaryngeal mechanism for pitch control.
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                Author and article information

                Journal
                Clin Exp Otorhinolaryngol
                Clin Exp Otorhinolaryngol
                CEO
                Clinical and Experimental Otorhinolaryngology
                Korean Society of Otorhinolaryngology-Head and Neck Surgery
                1976-8710
                2005-0720
                June 2015
                13 May 2015
                : 8
                : 2
                : 155-160
                Affiliations
                Department of Otolaryngology-Head and Neck Surgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea.
                Author notes
                Corresponding author: Ki Hwan Hong. Department of Otolaryngology-Head and Neck Surgery, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 561-712, Korea. Tel: +82-63-250-1990, Fax: +82-63-250-1986, khhong@ 123456chonbuk.ac.kr
                Article
                10.3342/ceo.2015.8.2.155
                4451541
                26045915
                55a8025a-1ac3-44e8-8c1a-f9b3830349a3
                Copyright © 2015 by Korean Society of Otorhinolaryngology-Head and Neck Surgery.

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 October 2013
                : 25 February 2014
                : 25 February 2014
                Funding
                Funded by: Chonbuk National University Hospital
                Categories
                Original Article

                Otolaryngology
                thyroidectomy,speech
                Otolaryngology
                thyroidectomy, speech

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