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A Multivariate Analysis of Objective Voice Changes After Thyroidectomy Without Laryngeal Nerve Injury
Serdar Akyildiz, MD;
Fatih Ogut, MD;
Mahir Akyildiz, MD;
Erkan Zeki Engin, PhD
Arch Otolaryngol Head Neck Surg. 2008;134(6):596-602.
Objective To evaluate the impact of thyroidectomy and the possible effects of factors such as patient sex, operation type, and surgeon experience on objective voice parameters of patients undergoing thyroidectomy without laryngeal nerve injury.
Design Prospective study.
Setting University hospital.
Patients Thirty-six patients undergoing primary thyroidectomy because of thyroid disease.
Main Outcome Measures The effect of thyroidectomy on voice was examined by recording the voices of the patients before and 1 week after thyroidectomy. The Multi-Dimensional Voice Program was used for capturing and analyzing the voice samples.
Results On postoperative examination of objective voice changes, thyroidectomy had no multivariate effect on the combination of voice parameters. Patient sex, type of surgery, and surgeon experience had no effect on the combination of voice parameters before and after thyroidectomy. Regardless of within-patient factors (type of surgery, patient sex, and surgeon experience), 4 acoustic parameters (highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, and degree of subharmonics) significantly decreased after thyroidectomy (P < .05). Although they tended to be worse, none of the acoustic parameters showed significant changes in male patients. However, significant changes in some of the acoustic parameters of female patients were observed. Highest fundamental frequency, standard deviation of average fundamental frequency, phonatory average fundamental frequency range in semitones, absolute jitter, relative average perturbation, pitch perturbation quotient, shimmer in decibels, percentage of shimmer, amplitude perturbation quotient, noise to harmonic ratio, and degree of subharmonics values were all lower in female patients after thyroidectomy (P < .05).
Conclusions Voice changes may occur after thyroidectomy without any evident laryngeal injury, and deterioration and amelioration of acoustic parameters can be observed to occur differently among male and female patients. Preoperative and postoperative objective voice analyses may be helpful in documenting voice changes.
Author Affiliations: Departments of Otolaryngology (Drs S. Akyildiz and Ogut) and General Surgery (Dr M. Akyildiz), Ege University Faculty of Medicine, and Department of Electrics and Electronics, Ege University Faculty of Engineering (Dr Engin), Izmir, Turkey.
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