AAO-HNS Guidelines Bundle

Improving Voice Outcomes after Thyroid Surgery

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Diagnosis Key Action Statements Preoperative Management Î BASELINE VOICE ASSESSMENT: The surgeon should document assessment of the patient's voice once a decision has been made to proceed with thyroid surgery. (R-C) Î PREOPERATIVE LARYNGEAL ASSESSMENT OF THE IMPAIRED VOICE: The surgeon should examine vocal fold (VF) mobility (or refer the patient to a clinician who can examine VF mobility) if the patient's voice is impaired (as determined by the assessment in Table 1) and a decision has been made to proceed with thyroid surgery. (R-C) Î PREOPERATIVE LARYNGEAL ASSESSMENT OF THE NONIMPAIRED VOICE: Once a decision has been made to proceed with thyroid surgery, the surgeon should examine VF mobility (or refer the patient to a clinician who can examine VF mobility) if the patient's voice is normal and the patient has: a. thyroid cancer with suspected extrathyroidal extension and/or b. prior neck surgery that places at risk the recurrent laryngeal or vagus nerve (eg, carotid endarterectomy, anterior approach to the cervical spine, cervical esophagectomy, and prior to thyroid or parathyroid surgery). Î PATIENT EDUCATION ON VOICE OUTCOMES: The clinician should educate the patient about the potential impact of thyroid surgery on voice once a decision has been made to proceed with thyroid surgery. (R-B) Î COMMUNICATION WITH ANESTHESIOLOGIST: The surgeon should inform the anesthesiologist of the results of abnormal preoperative laryngeal assessment in patients who have had laryngoscopy prior to thyroid surgery. (R-C)

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