Postoperative Voice Changes and Occult Recurrent Laryngeal Nerve Dysfunction Following Thyroidectomy
Occult Recurrent Laryngeal Nerve Dysfunction After Thyroidectomy
DOI:
https://doi.org/10.69750/dmls.03.07.0220Keywords:
Thyroidectomy, voice disorders, recurrent laryngeal nerve, vocal-fold paresis, dysphonia, videolaryngoscopyAbstract
Background: Voice disturbance following thyroidectomy may occur with or without recurrent laryngeal nerve injury, while mild nerve dysfunction may remain clinically silent.
Objective: To determine the frequency, pattern, recovery, and predictors of postoperative voice changes and occult recurrent laryngeal nerve dysfunction following thyroidectomy.
Methods: This prospective observational study included 120 adults undergoing thyroidectomy at Continental Medical College, Lahore, Pakistan, between March 2024 and December 2025. Assessments were performed preoperatively and at 48–72 hours, 2 weeks, 6 weeks, and 3 months using the Voice Handicap Index-10, perceptual voice grading, acoustic analysis, maximum phonation time, and flexible videolaryngoscopy. Patients with persistent dysfunction were followed for 6 months. Multivariable logistic regression identified factors associated with recurrent laryngeal nerve dysfunction.
Results: Clinically significant voice changes occurred in 39 patients (32.5%) at 48–72 hours and declined to 5 patients (4.2%) at 3 months. Recurrent laryngeal nerve dysfunction was detected in 11 patients (9.2%), corresponding to 5.5% of 200 nerves at risk. Four cases (36.4%) were occult. Among 109 patients with normal vocal-fold mobility, 32 (29.4%) developed clinically significant voice changes. Normal vocal-fold mobility was restored in 10 of 11 affected patients within 6 months. Central neck dissection, longer operative duration, and intraoperative loss of signal independently predicted postoperative recurrent laryngeal nerve dysfunction.
Conclusion: Post-thyroidectomy voice changes were more frequent than detected recurrent laryngeal nerve dysfunction. Routine or risk-based postoperative laryngoscopy may detect clinically silent paresis, while multidimensional voice assessment can identify non-paralytic dysfunction and support rehabilitation and specialist follow-up.
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