title: Voice Changes after Late Recurrent Laryngeal Nerve Identification Thyroidectomy.
abstract: OBJECTIVE
  To assess voice changes in patients after thyroidectomy where the recurrent laryngeal nerve (RLN) was found late in the thyroid dissection and where the RLN was not injured (late RLN identification technique).
  
  
  METHODS
  This study was conducted on 64 patients who underwent thyroidectomy by late RLN identification technique. Voice was assessed preoperatively, 1 week, 3 months, and 6 months after surgery using the voice assessment protocol and Voice Problem Self-Assessment Scale. The study group was divided into two subgroups (hemithyroidectomy: N = 13 and total thyroidectomy: N = 51). Voice assessments of both subgroups were then compared with a control group (N = 20) of patients who recently underwent extracervical surgeries.
  
  
  RESULTS
  All voice analysis differences between the control group and the individual study subgroup were nonsignificant. Dysphonia in the study group was significantly worse at 1 week and 3 months postoperatively but became nonsignificant at 6 months postoperatively. The deviations from the preoperative acoustic analysis were significant only in the first week postoperative comparison for fundamental frequency, noise-to-harmonic ratio, and maximal phonation time and thereafter became nonsignificant. Significant Voice Problem Self-Assessment Scale mean score increase (worsening) was also detected only at first week postoperatively.
  
  
  CONCLUSIONS
  Minimal voice changes were reported early after late RLN identification thyroidectomy in absence of RLN injury and disappeared gradually in a few months. Those changes are comparable with that of other extracervical surgeries, making thyroidectomy with late RLN identification a relatively safe technique as regard voice.
authors.affiliation: Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Ezzeddin
authors.initials: E
authors.lastname: Elsheikh
authors.affiliation: Unit of Phoniatrics, Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.
authors.forename: Amal Saeed
authors.initials: AS
authors.lastname: Quriba
authors.affiliation: Audiology Unit, Otorhinolaryngology Head and Neck Surgery Department, Faculty of Medicine, Zagazig University, Egypt.. Electronic address: mwenteg@yahoo.com.
authors.forename: Mohammad Waheed
authors.initials: MW
authors.lastname: El-Anwar
mesh_terms: D000162:Acoustics; D000328:Adult; D016022:Case-Control Studies; D004210:Dissection; D055154:Dysphonia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D061224:Laryngeal Nerve Injuries / Q000517:prevention & control*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010699:Phonation; D011446:Prospective Studies; D020127:Recovery of Function; D012009:Recurrent Laryngeal Nerve; D013061:Speech Acoustics; D013068:Speech Production Measurement; D011795:Surveys and Questionnaires; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014833:Voice Quality; D055815:Young Adult
keywords: dissection; dysphonia; recurrent laryngeal nerve; thyroidectomy; voice outcome