Voice and swallowing symptoms after thyroid surgery assessed using the <i>ThyVoice</i> online platform

Mihai, Radu

doi:10.1530/ETJ-23-0008

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Voice and swallowing symptoms after thyroid surgery assessed using the ThyVoice online platform

research-article

Author(s): Radu Mihai ¹ ^,

Publication date (Electronic): 28 April 2023

Journal: European Thyroid Journal

Publisher: Bioscientifica Ltd

Keywords: thyroid surgery, voice, swallowing, patient-reported outcomes

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Abstract

Objective

The aim of this multicentre study was to investigate the progression of patient-reported outcomes after thyroid surgery, with emphasis on voice and swallowing difficulties.

Methods

An online platform was used to collect replies to standardised questionnaires (voice handicap index, VHI; voice-related quality of life, VrQoL; EAT-10) preoperatively and at 2–6 weeks and 3–6–12 months after surgery.

Results

A total of 236 patients were recruited from five centres that contributed with median of 11 cases (range 2–186 cases). Average symptoms scores showed voice changes lasting up to 3 months: VHI increased from 41 ± 15 (preop) to 48 ± 21 (6 weeks) and returned to 41 ± 15 at 6 months. Similarly, VrQoL increased from 12 ± 4 to 15 ± 6 and returned to 12 ± 4 (6 months). Severe voice changes (VHI > 60) were reported in 12% of patients preop, 22% at 2 weeks, 18% at 6 weeks, 13% at 3 months and 7% at 12 months. Only five patients with normal preoperative voice had persistent severe voice changes after 6–12 months. Those with severe voice changes at 2 weeks (median VHI 70.5, IQR 65–81) had significant improvement by 6 months (median VHI 54, IQR 39–65) ( P < 0.001).

Swallowing assessment showed a median preop score of 0 (IQR 0–3) increasing to a median of 2 (IQR 0–8) at 2 weeks and normal values afterwards.

Conclusion

The ThyVoice online platform allows the assessment of patient-reported outcome measures in thyroid surgery. Voice morbidity appears to be more frequent than commonly reported, and this risk should the quoted during informed consent. Swallowing difficulties are mild but significant in the first 2 weeks.

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Most cited references 24

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Validity and reliability of the Eating Assessment Tool (EAT-10).

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The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10). The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses. A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (+/- SD) EAT-10 score of the normal cohort was 0.40 +/- 1.01. The mean EAT-10 score was 23.58 +/- 13.18 for patients with esophageal dysphagia, 23.10 +/- 12.22 for those with oropharyngeal dysphagia, 9.19 +/- 12.60 for those with voice disorders, 22.42 +/- 14.06 for those with head and neck cancer, and 11.71 +/- 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p <0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 +/- 10.5 to 5.2 +/- 7.4 after treatment (p <0.001). The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

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Clark A Rosen, Annie S Lee, Jamie Osborne … (2004)

The objective was to develop an abbreviated voice handicap assessment instrument and compare it with the Voice Handicap Index (VHI). Item analysis of the VHI in individuals without voice disorders and patients with voice disorders and creation and validation of the abbreviated VHI. Clinical consensus review of the VHI items was held to prioritize the clinical value of each of the VHI items (30 items in all). Item analysis of the VHI was performed using the VHI responses of 100 patients with voice problems and 159 control subjects. The 10 most robust VHI items were selected using the item analysis and clinical consensus results to form the Voice Handicap Index-10 (VHI-10). Statistical analysis comparing the validity of the VHI-10 with the VHI was performed with 819 patients representing a wide spectrum of voice disorders. Statistical analysis of the VHI and VHI-10 scores from the study group showed no statistically significant differences between the VHI and the VHI-10. Irrespective of diagnosis, the correlation between the VHI and the VHI-10 was greater than .90 (P = .01). The ratios of the VHI-10 to VHI scores for a variety of voice disorder categories were analyzed and found to be consistently greater than the expected value (33%). This suggests that the VHI-10 may be a more robust instrument than the VHI. The VHI-10 is a powerful representation of the VHI that takes less time for the patient to complete without loss of validity. Thus, the VHI-10 can replace the VHI as an instrument to quantify patients' perception of their voice handicap.

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Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement.

Pei-Yu Chiang, S. Snyder, Henning Dralle … (2010)

Intraoperative neural monitoring (IONM) during thyroid and parathyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. Despite the increasing use of IONM, review of the literature and clinical experience confirms there is little uniformity in application of and results from nerve monitoring across different centers. We provide a review of the literature and cumulative experience of the multidisciplinary International Neural Monitoring Study Group with IONM spanning nearly 15 years. The study group focused its initial work on formulation of standards in IONM as it relates to important areas: 1) standards of equipment setup/endotracheal tube placement and 2) standards of loss of signal evaluation/intraoperative problem-solving algorithm. The use of standardized methods and reporting will provide greater uniformity in application of IONM. In addition, this report clarifies the limitations of IONM and helps identify areas where additional research is necessary. This guideline is, at its forefront, quality driven; it is intended to improve the quality of neural monitoring, to translate the best available evidence into clinical practice to promote best practices. We hope this work will minimize inappropriate variations in monitoring rather than to dictate practice options.

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Author and article information

Journal

Journal ID (nlm-ta): Eur Thyroid J

Journal ID (iso-abbrev): Eur Thyroid J

Journal ID (publisher-id): ETJ

Title: European Thyroid Journal

Publisher: Bioscientifica Ltd (Bristol )

ISSN (Print): 2235-0640

ISSN (Electronic): 2235-0802

Publication date (Electronic): 28 April 2023

Publication date (Electronic preprint): 28 April 2023

Publication date Collection: 01 August 2023

Volume: 12

Issue: 4

Electronic Location Identifier: e230008

Affiliations

[1 ]Department of Endocrine Surgery , Churchill Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

Author notes

Correspondence should be addressed to R Mihai: radumihai@ 123456doctors.org.uk

^*ThyVoice contributors: patients recruited in this study were operated under the care of the following Consultant thyroid surgeons (in alphabetical order): Miss Julie Dunn, Mr Ashley Hey, Mr Shad Khan, Mr Radu Mihai, Mr Iain Nixon, Mr David Scott-Coombes, Mr Michael Stechman, Miss Isabel Quiroga.

Author information

Radu Mihai http://orcid.org/0000-0001-6153-1970

Article

Publisher ID: ETJ-23-0008

DOI: 10.1530/ETJ-23-0008

PMC ID: 10305707

PubMed ID: 37115021

SO-VID: 8acae75d-dc03-4922-bc66-295227cf83d7

License:

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.