title: Voice changes and thyroid surgery: is pre-operative indirect laryngoscopy necessary?
abstract: BACKGROUND
  Indirect laryngoscopy (IDL) is often performed prior to thyroid surgery to detect pre-existing vocal cord pathology.
  
  
  METHODS
  A retrospective chart review of 201 patients undergoing thyroid surgery at the Prince of Wales Hospital was undertaken in order to study the patterns of pre-operative and postoperative voice changes and IDL findings.
  
  
  RESULTS
  A total of 9% of patients had pre-operative voice symptoms, and 22% of this group had abnormalities detected on pre-operative IDL. Of 160 documented IDL, 4% revealed vocal cord pathology in asymptomatic patients, including an asymptomatic recurrent laryngeal nerve palsy.
  
  
  CONCLUSIONS
  Indirect laryngoscopy remains a useful but flawed pre-operative screening tool for patients with voice symptoms, but the literature suggests that more advanced phoniatric tests will provide superior diagnostic sensitivity. The role of routine pre-operative laryngoscopy for asymptomatic patients is of debatable value.
authors.affiliation: Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Yeung
authors.forename: C
authors.initials: C
authors.lastname: Erskine
authors.forename: P
authors.initials: P
authors.lastname: Mathews
authors.forename: P J
authors.initials: PJ
authors.lastname: Crowe
mesh_terms: D006685:Hoarseness; D006801:Humans; D061224:Laryngeal Nerve Injuries; D007828:Laryngoscopy / Q000379:methods; D011300:Preoperative Care; D061226:Recurrent Laryngeal Nerve Injuries; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000534:rehabilitation*; D014827:Vocal Cords / Q000473:pathology; D014833:Voice Quality