title: The therapeutic decision making of the unilateral vocal cord palsy after thyroidectomy using thyroidectomy-related voice questionnaire (TVQ).
abstract: The objective of this study was to investigate the efficacy of early management of post-thyroidectomy unilateral vocal cord palsy (UVCP) and the clinical utility of the thyroidectomy-related voice questionnaire (TVQ) when planning UVCP treatment. The study group comprised 48 consecutive patients diagnosed with UVCP after thyroidectomy. Laryngoscopic examination and voice analysis were conducted, and the TVQ was administered pre-thyroidectomy and at 2 weeks and 1, 3, 6, and 12 months post-thyroidectomy. Twenty-five patients with aspiration symptoms and severe vocal difficulties received injection laryngoplasty, and 23 with no aspiration symptoms and relatively mild vocal difficulties underwent voice therapy. We performed a video fluoroscopic swallowing study on each patient 2 weeks after thyroidectomy and 1 month following the procedure. The average total TVQ scores 2 weeks post-thyroidectomy were 51.92 ± 11.42 in the injection laryngoplasty group and 35.78 ± 12.99 in the voice therapy group. Both subjective and objective parameters improved significantly at 1 month after treatment and continued to improve slowly over the next 12 months (p < 0.01) in both groups. TVQ scores were significantly lower in the injection laryngoplasty group than in the voice therapy group 1 month post-intervention (p < 0.01). At the study end point, the greatest improvement in subjective symptoms occurred in temporary VCP patients who underwent injection laryngoplasty. The optimal TVQ score cut-off distinguishing the two groups was 45 (68.0 % sensitivity, 78.3 % specificity). In conclusion, early management following timely diagnosis of post-thyroidectomy UVCP can improve symptoms within 1 month. Moreover, application of TVQ will aid clinicians to plan treatment for postoperative VCP patients.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 137-701, Korea.
authors.forename: Byung-Joon
authors.initials: BJ
authors.lastname: Chun
authors.forename: Ja-Sung
authors.initials: JS
authors.lastname: Bae
authors.forename: Byung-Joo
authors.initials: BJ
authors.lastname: Chae
authors.forename: Jun-Ook
authors.initials: JO
authors.lastname: Park
authors.forename: Inn-Chul
authors.initials: IC
authors.lastname: Nam
authors.forename: Chung-Soo
authors.initials: CS
authors.lastname: Kim
authors.forename: Kwang-Jae
authors.initials: KJ
authors.lastname: Cho
authors.forename: Yeon-Shin
authors.initials: YS
authors.lastname: Hwang
authors.forename: Mi-Ran
authors.initials: MR
authors.lastname: Shim
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Park
authors.forename: Dong-Il
authors.initials: DI
authors.lastname: Sun
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006801:Humans; D058753:Laryngoplasty; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000628:therapy*; D014834:Voice Training; D055815:Young Adult