Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia.
BACKGROUND
Reliable voice grading systems to identify postoperative voice dysfunction by surgeons are needed.


OBJECTIVE
To examine the utility of patient-reported and clinician-determined voice assessment in identifying postthyroidectomy voice dysfunction.


METHODS
Fifty patients enrolled in a prospective observational trial evaluating voice function perioperatively by patient-reported symptoms (Voice Case History [VCHx]) and perceived voice handicap (Voice Handicap Index [VHI]), clinician-determined judgment of voice quality (Consensus Auditory-Perceptual Evaluation--Voice [CAPE-V]), and laryngeal examination via video laryngoscopy (VLS). Voice dysfunction at first postoperative visit in symptomatic patients was defined by objective laryngeal abnormalities on VLS. Postoperative changes from baseline in voice parameters were compared between patients with and without voice dysfunction using the Wilcoxon rank sum test. Receiver operating characteristics were evaluated to determine area under the curve (AUC) for tested parameters.


RESULTS
Eight (16%) had early transient and 1 (2%) had permanent postoperative voice dysfunction. VCHx symptoms had negative (NPV) and positive (PPV) predictive values of 96%-100% and 39%-53%, respectively for voice dysfunction. The rating of overall severity from the CAPE-V was highly predictive (AUC = 0.96), and a change in severity from preoperative baseline >or=20% at 1-2 weeks had a PPV of 86% and NPV of 95% for postoperative dysphonia. Patient-reported total VHI score was most predictive (AUC = 0.97) and a change in VHI from preoperative baseline >or=25 early postoperatively had a PPV of 88% and NPV of 97% for postoperative dysphonia.


CONCLUSIONS
Patient self-assessment of voice handicap using the VHI reliably identifies voice dysfunction after thyroidectomy. Patients with a change in VHI >or=25 from preoperative baseline warrant early referral to speech pathology and laryngology.
Department of Surgery, Division of Surgical Oncology, Walter Reed Army Medical Center, and the United States Military Cancer Institute, Washington, DC 20307, USA. alexander.stojadinovic@na.amedd.army.mil
Alexander
A
Stojadinovic
Leonard R
LR
Henry
Robin S
RS
Howard
Joyce
J
Gurevich-Uvena
Matthew J
MJ
Makashay
George L
GL
Coppit
Craig D
CD
Shriver
Nancy P
NP
Solomon
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006306:Health Surveys; D006801:Humans; D007828:Laryngoscopy; D007830:Larynx / Q000502:physiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010819:Physician's Role; D011446:Prospective Studies; D012649:Self Concept; D012720:Severity of Illness Index; D049489:Stroboscopy; D013965:Thyroidectomy / Q000009:adverse effects*; D014831:Voice / Q000502:physiology; D014832:Voice Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology