Clin Exp Otorhinolaryngol.  2022 Feb;15(1):24-48. 10.21053/ceo.2021.00633.

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

• Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force
• Ryu CH
• Lee SJ
• Cho JG
• Choi IJ
• Choi YS
• Hong YT
• Jung SY
• Kim JW
• Lee DY
• Lee DK
• Lee G
• Lee SJ
• Lee YC
• Lee YS
• Nam IC
• Park KN
• Park YM
• Sung ES
• Son HY
• Seo IH
• Lee BJ
• Lim JY

• KMID: 2527111
• DOI: http://doi.org/10.21053/ceo.2021.00633

Abstract

Voice change is a common complaint after thyroid surgery and has a significant impact on quality of life. The Korean Society of Laryngology, Phoniatrics and Logopedics assembled a task force to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations encompass preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, and include in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQs) in three categories—preoperative (KQ 1–2), intraoperative (KQ 3–8), and postoperative (KQ 9–14) management—and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. A detailed evidence profile is presented for each recommendation. The level of evidence for each recommendation was classified as high-quality, moderate-quality, or low-quality. The strength of each recommendation was designated as strong or weak considering the level of evidence supporting the recommendation. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

Keyword

Thyroidectomy; Guideline; Voice; Dysphonia; Thyroid Neoplasms

Figure

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  Fig. 1. Flow diagram for the literature search. KQ, key question; SLN, superior laryngeal nerve; RLN, recurrent laryngeal nerve; IONM, intraoperative neuromonitoring; VFP, vocal fold paralysis.

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  Fig. 2. Voice education after thyroid surgery.

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  Fig. 3. (A-D) Neck exercise after thyroid surgery.

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  Fig. 4. (A, B) Laryngeal massage after thyroid surgery.

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  Fig. 5. (A-C) Neck posture adjustments after thyroid surgery.

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  Fig. 6. Flowchart for the care and management of voice change after thyroid surgery. KQ, key question; VAS, visual analog scale; GRBAS, Grade, Roughness, Breathiness, Asthenia, and Strain; VHI, Voice Handicap Index; IONM, intraoperative neuromonitoring; EBSLN, external branch of the superior laryngeal nerve; RLN, recurrent laryngeal nerve; MPT, maximum phona- tion time; MDVP, Multi-Dimensional Voice Program; VRP, voice range profile; CPP, cepstral peak prominence; VFP, vocal fold paralysis.

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