Evaluating the incidence, clinical significance and predictors for vocal cord palsy and incidental laryngopharyngeal conditions before elective thyroidectomy: is there a case for routine laryngoscopic examination?
BACKGROUND
Routine preoperative laryngeal examination remains controversial. We aimed to assess the utility of preoperative routine flexible laryngoscopy (FL) by looking at the incidence, clinical significance and predictors for preoperative vocal cord paresis (VCP) and incidental laryngopharyngeal conditions (LPC) in our consecutive cohort.


METHODS
A total of 302 patients underwent laryngeal examination by an independent otorhinolaryngologist and were specifically asked about voice/swallowing symptoms suggestive of VCP 1 day before surgery. As well as vocal cord (VC) mobility, the naso-pharynx and larynx were examined using FL. Any VCP and/or LPC was recorded. VCP was defined as reduced or absent movement in one or more VC. An LPC was considered clinically significant if the ensuing thyroidectomy was changed or deferred.


RESULTS
Seven (2.3 %) patients had preoperative VCP, while an additional seven patients had an incidental LPC. Of the seven VCPs, five were caused by previous thyroidectomy, while two were caused by a benign goitre. The incidence of asymptomatic VCP in a previously non-operated cohort was 1/245 (0.41 %). Voice/swallowing symptoms (p = 0.033) and previous thyroidectomy (p < 0.001) were the two significant predictors for VCP. The seven incidental LPCs were vallecular cyst (n = 1), VC scar and polyp (n = 2), nasopharyngeal cyst and polyp (n = 3) and redundant arytenoid mucosa (n = 1); however, as they were benign, all seven patients proceeded to thyroidectomy as planned.


CONCLUSIONS
Given the low incidence (0.41 %) of asymptomatic VCP in a previously non-operated cohort and that none of the seven LPCs were considered clinically significant, routine preoperative laryngoscopic examination should be reserved for those with previous thyroidectomy and/or voice/swallowing symptoms.
Division of Endocrine Surgery, Department of Surgery, University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, SAR, Hong Kong, blang@hkucc.hku.hk.
Brian Hung-Hin
BH
Lang
Kevin Ka-Wan
KK
Chu
Raymond King-Yin
RK
Tsang
Kai Pun
KP
Wong
Birgitta Yee-Hang
BY
Wong
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017558:Elective Surgical Procedures; D005260:Female; D006042:Goiter / Q000601:surgery; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D007818:Laryngeal Diseases / Q000453:epidemiology*; D007828:Laryngoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000453:epidemiology*; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy; D014826:Vocal Cord Paralysis / Q000453:epidemiology*; D055815:Young Adult