title: Thyroidectomy in the professional singer-neural monitored surgical outcomes.
abstract: BACKGROUND
  Voice changes commonly occur from thyroidectomy and may be due to neural or nonneural causes. Such changes can be a source of significant morbidity for any patient, but thyroidectomy in the professional singer carries special significance. We test the hypothesis that the career of singers and professional voice users is not impaired after neural monitored thyroid surgery.
  
  
  METHODS
  A quantitative analysis of pre- and postoperative neural monitored thyroid surgery voice outcomes utilizing three validated vocal instruments-Voice Handicap Index (VHI), Singing Voice Handicap Index (SVHI), and Evaluation of Ability to Sing Easily (EASE)-in a unique series of professional singers/voice users was performed. Additional quantitative analysis related to final intraoperative electromyography (EMG) amplitude, the time to return to performance, and vocal parameters affected during this interval was performed.
  
  
  RESULTS
  Twenty-seven vocal professionals undergoing thyroidectomy were identified, of whom 60% had surgery for thyroid cancer. Pre- and postsurgery flexible fiberoptic laryngeal exams were normal in all patients. Return to performance rate was 100%, and mean time to performance was 2.26 months (±1.61). All three vocal instrument mean scores, pre-op vs. post-op, were unchanged: VHI, 4.15 (±5.22) vs. 4.04 (±3.85), p=0.9301; SVHI, 11.26 (±14.41) vs.12.07 (±13.09), p=0.8297; and EASE, 6.19 (±9.19) vs. 6.00 (±7.72), p=0.9348. The vocal parameters most affected from surgery until first performances were vocal fatigue (89%), high range (89%), pitch control and modulation (74%), and strength (81%). Final mean intraoperative EMG amplitude was within normal limits for intraoperative stimulation and had no relationship with time to first professional performance (p=0.7199).
  
  
  CONCLUSIONS
  Neural monitored thyroidectomy, including for thyroid malignancy, in professional voice users is safe without any changes in three different voice/singing instruments, with 100% return to performance. Intraoperative EMG data at the conclusion of surgery and postoperative laryngeal exam were normal in all patients. Specific vocal parameters are transiently affected during the postoperative recovery phase, which is important to outline in the consent process of this unique patient population and may provide insight into the physiologic state of the larynx subsequent to thyroid surgery.
authors: 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.|2Division of Surgical Oncology, Endocrine Surgical Service, Massachusetts General Hospital, Boston, Massachusetts.
authors: Gregory W
authors: GW
authors: Randolph
authors: 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors: Niranjan
authors: N
authors: Sritharan
authors: 3Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors: Phil
authors: P
authors: Song
authors: 3Division of Laryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors: Ramon
authors: R
authors: Franco
authors: 1Division of Thyroid and Parathyroid Surgery, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.
authors: Dipti
authors: D
authors: Kamani
authors: 4Division of Otolaryngology - Head and Neck Surgery, Southern Illinois School of Medicine, Springfield, Illinois.
authors: Gayle
authors: G
authors: Woodson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D004576:Electromyography; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries / Q000517:prevention & control; D007823:Laryngeal Nerves; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009790:Occupations; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D062707:Return to Work; D063346:Singing; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D014630:Vagus Nerve; D061223:Vagus Nerve Injuries / Q000517:prevention & control; D014831:Voice; D014832:Voice Disorders / Q000517:prevention & control*; D014833:Voice Quality; D055815:Young Adult