Association Between Age and Patient-Reported Changes in Voice and Swallowing After Thyroidectomy

Overview

Journal Laryngoscope

Specialty Otorhinolaryngology

Date 2018 Sep 9

PMID 30194684

Citations 14

Authors

Zeyad Sahli

Joseph K Canner

Omar Najjar

Eric B Schneider

Jason D Prescott

Jonathon O Russell

Ralph P Tufano

Martha A Zeiger

Aarti Mathur

Affiliations

Soon will be listed here.

Abstract

Objectives: Despite intact recurrent laryngeal nerves, patient-reported voice and swallowing changes are common after thyroidectomy. The association between patient age or frailty status and these changes is unknown. The aim of this study was to evaluate the impact of age and frailty on the incidence of voice and swallowing alterations after thyroidectomy.

Methods: We performed an institutional review board (IRB)-approved retrospective review of consecutive patients who underwent total thyroidectomy with intraoperative recurrent laryngeal nerve (RLN) monitoring at a single institution between January 2014 and September 2016. Patients with RLN injury were excluded. After data extraction, a modified frailty index (mFI) was calculated for each patient. The association among risk factors, including age, mFI, prior history of neck surgery, frequent voice use, presence of malignancy or gastroesophageal reflux disease, and smoking status and reported voice and/or swallowing changes was examined.

Results: Of 924 patients undergoing thyroidectomy, 148 (16.0%) reported only changes in voice; 52 (5.6%) reported only difficulty in swallowing; and 26 (2.8%) reported changes with both voice and swallowing. On multivariate analysis, we found a significant increase in voice or swallowing alterations up to the age of 50 years (5% increased odds per year), after which these changes plateaued. We found that mFI was not associated with voice or swallowing changes.

Conclusion: Age ≥ 50 years is independently associated with the development of voice or swallowing changes after thyroidectomy, despite intact RLN. Additional prospective studies are needed to validate these findings, further define this association, and identify risk factors for developing these changes.

Level Of Evidence: 2b Laryngoscope, 129:519-524, 2019.

Citing Articles

Prospective Voice Assessment After Thyroidectomy Without Recurrent Laryngeal Nerve Injury.

Simic Prgomet I, Frkanec S, Gugic Radojkovic I, Prgomet D Diagnostics (Basel). 2025; 15(1.

PMID: 39795565 PMC: 11720102. DOI: 10.3390/diagnostics15010037.

Impact of Frailty on Post-Treatment Dysphagia in Patients with Head and Neck Cancer.

Hurtado-Oliva J, van der Laan H, de Vries J, Steenbakkers R, Halmos G, Wegner I Dysphagia. 2024; .

PMID: 39196352 DOI: 10.1007/s00455-024-10754-7.

Fluorescence imaging to visualize the recurrent laryngeal nerve during thyroidectomy procedures: analysis of 65 cases and 81 nerves.

Dip F, Falco J, White K, Rosenthal R Surg Endosc. 2024; 38(3):1406-1413.

PMID: 38168731 DOI: 10.1007/s00464-023-10627-4.

Prevalence and risk factors for dysphagia in older adults after thyroid and parathyroid surgery.

Crepeau P, Sutton W, Sahli Z, Fedorova T, Russell J, Zeiger M Surgery. 2023; 175(1):99-106.

PMID: 37945476 PMC: 10841879. DOI: 10.1016/j.surg.2023.04.066.

Results of Swallowing Assessment in the Immediate Postoperative Period in Patients Following Surgery for Thyroid Malignancies.

Tm R, Krishnan K, Thiagarajan S, Balaji A, Chaukar D Indian J Otolaryngol Head Neck Surg. 2023; 75(3):1474-1479.

PMID: 37636624 PMC: 10447709. DOI: 10.1007/s12070-023-03608-5.

References

Vini L, Hyer S, Marshall J, AHern R, Harmer C . Long-term results in elderly patients with differentiated thyroid carcinoma. Cancer. 2003; 97(11):2736-42. DOI: 10.1002/cncr.11410. View

Velanovich V, Antoine H, Swartz A, Peters D, Rubinfeld I . Accumulating deficits model of frailty and postoperative mortality and morbidity: its application to a national database. J Surg Res. 2013; 183(1):104-10. DOI: 10.1016/j.jss.2013.01.021. View

Lally F, Crome P . Understanding frailty. Postgrad Med J. 2007; 83(975):16-20. PMC: 2599957. DOI: 10.1136/pgmj.2006.048587. View

Papadakis C, Asimakopoulou P, Proimos E, Perogamvrakis G, Papoutsaki E, Chimona T . Subjective and Objective Voice Assessments After Recurrent Laryngeal Nerve-Preserved Total Thyroidectomy. J Voice. 2017; 31(4):515.e15-515.e21. DOI: 10.1016/j.jvoice.2016.12.011. View

Gohrbandt A, Aschoff A, Gohrbandt B, Keilmann A, Lang H, Musholt T . Changes of Laryngeal Mobility and Symptoms Following Thyroid Surgery: 6-Month Follow-Up. World J Surg. 2015; 40(3):636-43. DOI: 10.1007/s00268-015-3323-y. View

Takeuchi K, Aida J, Ito K, Furuta M, Yamashita Y, Osaka K . Nutritional status and dysphagia risk among community-dwelling frail older adults. J Nutr Health Aging. 2014; 18(4):352-7. DOI: 10.1007/s12603-014-0025-3. View

Soylu L, Ozbas S, Uslu H, Kocak S . The evaluation of the causes of subjective voice disturbances after thyroid surgery. Am J Surg. 2007; 194(3):317-22. DOI: 10.1016/j.amjsurg.2006.10.009. View

Rulli F, Ambrogi V, Dionigi G, Amirhassankhani S, Mineo T, Ottaviani F . Meta-analysis of recurrent laryngeal nerve injury in thyroid surgery with or without intraoperative nerve monitoring. Acta Otorhinolaryngol Ital. 2014; 34(4):223-9. PMC: 4157532. View

Makary M, Segev D, Pronovost P, Syin D, Bandeen-Roche K, Patel P . Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010; 210(6):901-8. DOI: 10.1016/j.jamcollsurg.2010.01.028. View

10.

McIvor N, Flint D, Gillibrand J, Morton R . Thyroid surgery and voice-related outcomes. Aust N Z J Surg. 2000; 70(3):179-83. DOI: 10.1046/j.1440-1622.2000.01781.x. View

11.

Lee J, Breen D, Scott A, Grodski S, Yeung M, Johnson W . Quantitative study of voice dysfunction after thyroidectomy. Surgery. 2016; 160(6):1576-1581. DOI: 10.1016/j.surg.2016.07.015. View

12.

Grogan R, Aschebrook-Kilfoy B, Angelos P . Interventions to improve thyroid cancer survivors' quality of life. Future Oncol. 2016; 12(11):1309-11. DOI: 10.2217/fon-2016-0052. View

13.

Hong K, Kim Y . Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg. 1997; 117(4):399-404. DOI: 10.1016/S0194-5998(97)70133-5. View

14.

Sura L, Madhavan A, Carnaby G, Crary M . Dysphagia in the elderly: management and nutritional considerations. Clin Interv Aging. 2012; 7:287-98. PMC: 3426263. DOI: 10.2147/CIA.S23404. View

15.

Barczynski M, Randolph G, Cernea C, Dralle H, Dionigi G, Alesina P . External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope. 2013; 123 Suppl 4:S1-14. DOI: 10.1002/lary.24301. View

16.

Vidal Fortuny J, Guigard S, Karenovics W, Triponez F . Surgery of the thyroid: recent developments and perspective. Swiss Med Wkly. 2015; 145:w14144. DOI: 10.4414/smw.2015.14144. View

17.

Toniato A, Bernardi C, Piotto A, Rubello D, Pelizzo M . Features of papillary thyroid carcinoma in patients older than 75 years. Updates Surg. 2011; 63(2):115-8. DOI: 10.1007/s13304-011-0060-0. View

18.

Lombardi C, Raffaelli M, DAlatri L, Marchese M, Rigante M, Paludetti G . Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery. 2006; 140(6):1026-32. DOI: 10.1016/j.surg.2006.08.008. View

19.

Fried L, Tangen C, Walston J, Newman A, Hirsch C, Gottdiener J . Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3):M146-56. DOI: 10.1093/gerona/56.3.m146. View

20.

Lombardi C, Raffaelli M, De Crea C, DAlatri L, Maccora D, Marchese M . Long-term outcome of functional post-thyroidectomy voice and swallowing symptoms. Surgery. 2009; 146(6):1174-81. DOI: 10.1016/j.surg.2009.09.010. View