title: Computerized acoustic voice analysis and subjective scaled evaluation of the voice can avoid the need for laryngoscopy after thyroid surgery.
abstract: BACKGROUND
  Because of frequent postoperative alterations in voice, many surgeons include laryngoscopy as a routine examination before/after thyroid surgery. The aim of this work was to determine whether more comfortable and easier subjective or objective postoperative voice assessments could complement or replace laryngoscopy.
  
  
  METHODS
  Sixty-four consecutive patients scheduled to undergo thyroid surgery underwent preoperative objective computerized acoustic voice analysis (CAVA), subjective scaled evaluation of the voice (SSEV) with the GIRBAS scale, and fiberoptic laryngoscopy. All patients had 7- and 30-day postoperative follow-up assessments using the same tests.
  
  
  RESULTS
  CAVA measurements of jitter and noise-to-harmonic ratio showed the most frequent variations (36% and 31%, respectively) between the first and second tests. The mean preoperative SSEV GIRBAS value was 1.3 (range, 0-7) and had deteriorated in 36% of patients at 30 days postoperatively. All patients had a normal preoperative laryngoscopy. At 7 days postoperatively, 5 (8%) patients suffered unilateral vocal cord palsy which recovered in 2 (5%) patients after 1 month. GIRBAS values showed differences between patients with and without a vocal cord palsy both 7 and 30 days postoperatively (P < .05). The vocal parameters jitter and shimmer showed differences (P < .02 each) between patients with or without vocal cord palsy. When there was a change in >or=3 vocal parameters, vocal cord palsy was confirmed by laryngoscopy.
  
  
  CONCLUSIONS
  After thyroid surgery, vocal cord palsy may be suspected when there is an alteration in GIRBAS scale or in several parameters of the CAVA. Laryngoscopy may only be necessary when the CAVA and SSEV are abnormal.
authors.affiliation: Hospital Clínico Universitario, Department of Surgery, Unit of Endocrine and Bariatric Surgery, University of Valencia, Valencia, Spain. joaquin.ortega@uv.es
authors.forename: Joaquin
authors.initials: J
authors.lastname: Ortega
authors.forename: Norberto
authors.initials: N
authors.lastname: Cassinello
authors.forename: Dimitri
authors.initials: D
authors.lastname: Dorcaratto
authors.forename: Ennio
authors.initials: E
authors.lastname: Leopaldi
mesh_terms: D000162:Acoustics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013068:Speech Production Measurement / Q000379:methods; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology; D014832:Voice Disorders / Q000175:diagnosis* / Q000209:etiology*; D014833:Voice Quality