title: Voice outcomes after total thyroidectomy, partial thyroidectomy, or non-neck surgery using a prospective multifactorial assessment.
abstract: BACKGROUND
  Voice alteration remains a significant complication of thyroid surgery. We present a comparison of voice outcomes between total thyroidectomy (TT), partial thyroidectomy (PT), and non-neck (NN) surgery using a multifactorial voice-outcomes classification tool.
  
  
  METHODS
  Patients with normal voice (n = 112) were enrolled between July 2004 and March 2009. The patients underwent TT (n = 54), PT (n = 35), or NN (n = 23) surgery under general endotracheal anesthesia as part of a prospective observational study involving serial multimodality voice evaluation preoperatively, and at 2 weeks, 3 months, and 6 months postoperatively. Patients with adverse voice outcomes were grouped into the negative voice outcomes (NegVO) category, including patients with objective (abnormality on videolaryngostroboscopy and substantial voice dysfunction) and subjective (normal videolaryngostroboscopy but with notable voice impairment) NegVO. Voice outcomes were compared among study groups.
  
  
  RESULTS
  Negative voice outcomes occurred in 46% (95% CI, 34-59%) and 14% (95% CI, 6-30%) of TT and PT groups, respectively. No NegVOs were observed after NN surgery. Early NegVOs were more common in the TT group than in the NN or PT groups (p < 0.001). Most voice disturbances resolved by 6 months (TT 84%; PT 92%) with no difference in NegVO among all groups (p = 0.23). Black race and significant changes in certain voice outcomes measures at the 2-week follow-up visit were identified as predictors of late (3 to 6 months) NegVO.
  
  
  CONCLUSIONS
  This comprehensive voice outcomes study revealed that the extent of thyroidectomy impacts voice outcomes in the early postoperative period, and identified risk factors for late NegVO in post-thyroidectomy patients who should be considered for early voice rehabilitation referral.
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Diego A
authors.initials: DA
authors.lastname: Vicente
authors.affiliation: Audiology and Speech Center, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Nancy P
authors.initials: NP
authors.lastname: Solomon
authors.affiliation: Uniformed Services University of the Health Sciences, Bethesda, MD; Bon Secours Cancer Institute, Richmond, VA.
authors.forename: Itzhak
authors.initials: I
authors.lastname: Avital
authors.affiliation: Indiana University Health, Goshen Center for Cancer Care, Goshen, IN.
authors.forename: Leonard R
authors.initials: LR
authors.lastname: Henry
authors.affiliation: Department of Research Programs, Biostatistics Section, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Robin S
authors.initials: RS
authors.lastname: Howard
authors.affiliation: Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Leah B
authors.initials: LB
authors.lastname: Helou
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: George L
authors.initials: GL
authors.lastname: Coppit
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Shriver
authors.affiliation: Department of Surgery, Regional Anesthesia and Pain Management Initiative, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD.
authors.forename: Chester C
authors.initials: CC
authors.lastname: Buckenmaier
authors.affiliation: Department of Surgery, Montefiore Medical Center, Bronx, NY.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Libutti
authors.affiliation: Department of Surgical Oncology, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
authors.affiliation: Department of Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of the Health Sciences, Bethesda, MD; United States Military Cancer Institute, Bethesda, MD; Bon Secours Cancer Institute, Richmond, VA. Electronic address: stojadinovicmd2011@gmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000328:Adult; D000465:Algorithms; D050110:Bariatric Surgery; D017081:Cholecystectomy, Laparoscopic; D003661:Decision Support Techniques; D055154:Dysphonia / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D059685:Herniorrhaphy; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D016105:Parathyroidectomy; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D013965:Thyroidectomy / Q000379:methods