title: Types and timing of therapy for vocal fold paresis/paralysis after thyroidectomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary decision-making pathway.
  
  
  METHODS
  Meta-analysis.
  
  
  METHODS
  Four databases and one journal were searched using the key words of "thyroidectomy," "vocal cord paresis/paralysis," and "therapy." Study quality was evaluated using the Cochrane Collaboration's risk of bias tools. Data regarding type and timing of therapy were extracted from 39 articles. Odds ratios (ORs), relative risk (RR), 95% confidence interval, and heterogeneity were recorded. Logistic regression analysis was performed to determine the relationships between timing and OR/RR.
  
  
  RESULTS
  Among the 13 studies investigating unilateral paresis/paralysis, five focused on early therapy (0-6 months). In these studies, the OR for clinical heterogeneity was significantly higher after neurolysis than after injection laryngoplasty and voice training (Q = 17.002, I(2) = 78%, P = 0.000), and the RR for heterogeneity was significantly higher after injection laryngoplasty at ≥12 months than <12 months (Q = 9.984, I(2) = 89.9%, P = 0.002). In the 26 studies that investigated bilateral paresis/paralysis, the OR for heterogeneity was significantly higher for bilateral posterior cordectomy than for endolaryngeal laterofixation (Q = 3.510, I(2) = 71.5%, P = 0.061) and laser arytenoidectomy with posterior cordectomy (Q = 2.90, I(2) = 65.6%, P = 0.088).
  
  
  CONCLUSIONS
  For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months.
authors.affiliation: Department of Ear, Nose and Throat, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Xuhui
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Voice and Swallowing Rehabilitation, Rehabilitation School, Shanghai University of Traditional Chinese Medicine, Shanghai, China. Electronic address: wanping2000@hotmail.com.
authors.forename: Ping
authors.initials: P
authors.lastname: Wan
authors.affiliation: Department of Ear, Nose and Throat, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Yabin
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Ear, Nose and Throat, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Voice and Swallowing Rehabilitation, Rehabilitation School, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Yanyan
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Department of Ear, Nose and Throat, Yueyang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Huang
authors.affiliation: Department of Voice Science, Key National Laboratory of Speech and Hearing Science, East China Normal University, Shanghai, China.
authors.forename: Zaoming
authors.initials: Z
authors.lastname: Huang
mesh_terms: D006801:Humans; D058753:Laryngoplasty / Q000009:adverse effects; D016015:Logistic Models; D009407:Nerve Block / Q000009:adverse effects; D016017:Odds Ratio; D010699:Phonation; D020127:Recovery of Function; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012086:Reoperation; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects*; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014827:Vocal Cords / Q000503:physiopathology / Q000601:surgery*; D014831:Voice; D014834:Voice Training
keywords: Therapy; Thyroidectomy; Vocal fold paresis/paralysis