title: How can we screen voice problems effectively in patients undergoing thyroid surgery?
abstract: BACKGROUND
  Voice problems following thyroid surgery are well known, and perioperative voice analysis in patients undergoing thyroidectomy no longer seems optional. However, multiple means of assessing vocal function are time-consuming, require specific instruments and specialists, and increase costs. Therefore, we designed this study to develop an efficient and cost-effective screening tool for detecting voice disorders following thyroidectomy.
  
  
  METHODS
  We developed the Perioperative Voice-Screening Protocol for Thyroid Surgery (PVST) using the Thyroidectomy-Related Voice Questionnaire (TVQ) to provide a cost-effective diagnostic flow chart for patients following thyroidectomy. The TVQ is a simple questionnaire that was developed at our institution and has already demonstrated its effectiveness in detecting pre- and postthyroidectomy voice-related disorders in our previous studies. To investigate the PVST, we enrolled 242 subjects who underwent thyroidectomy and let them follow the PVST. All subjects underwent a voice work-up by a voice specialist to verify the predictive value of the protocol.
  
  
  RESULTS
  Using PVST, we could effectively screen for abnormal preoperative laryngeal findings with sensitivity and specificity of 82.1% and 50.5%, respectively, especially laryngeal benign mucosal disease with sensitivity and specificity of 100% and 45.6%, respectively. We could also screen for postoperative voice-related problems with sensitivity and specificity of 100% and 50.4% for detecting vocal-cord palsy, and 66.7% and 51.2% for detecting a low-pitched voice, respectively. If all 242 patients followed the protocol, US $42,768 would be saved, and the PVST was estimated to decrease costs by 43.5%.
  
  
  CONCLUSIONS
  The PVST is a reliable and cost-effective perioperative screening tool that enables thyroid surgeons to detect patients with voice problems in their routine outpatient clinic for early and appropriate referral to voice specialists.
authors.affiliation: 1 Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea , Seoul, Korea.
authors.forename: Jun-Ook
authors.initials: JO
authors.lastname: Park
authors.forename: Ja-Sung
authors.initials: JS
authors.lastname: Bae
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Chae
authors.forename: Choung Soo
authors.initials: CS
authors.lastname: Kim
authors.forename: Inn-Chul
authors.initials: IC
authors.lastname: Nam
authors.forename: Byung-Joon
authors.initials: BJ
authors.lastname: Chun
authors.forename: Mi-Ran
authors.initials: MR
authors.lastname: Shim
authors.forename: Yeon-Shin
authors.initials: YS
authors.lastname: Hwang
authors.forename: Min-Sik
authors.initials: MS
authors.lastname: Kim
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Sun
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010699:Phonation; D011184:Postoperative Period; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000175:diagnosis; D014827:Vocal Cords / Q000503:physiopathology; D014831:Voice; D014832:Voice Disorders / Q000175:diagnosis*