AAO-HNS Guidelines Bundle

Improving Voice Outcomes after Thyroid Surgery

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NO Document baseline assessment of patient's voice Is the patient's voice impaired? Monitor laryngeal electromyography (EMG) during surgery Any change in the patient's voice between 2 weeks and 2 months following surgery? Patient aged ≥18 years undergoing thyroid surgery Option A. Thyroid cancer with suspected extrathyroidal extension B. History of prior neck surgery YES Algorithm of Guideline's Key Action Statements Does the patient have: A and/or B Examine the patient's VF motion or refer for examination Educate patient about the potential impact of thyroid surgery on the voice NO Inform the anesthesiologist of abnormal preoperative laryngeal assessment Identify the RLN during thyroid surgery Take steps to preserve the EBSLN YES Document voice changes in the patient's medical record Examine VF mobility or refer for examination Abnormal VF mobility? Refer to an otolaryngologist Counsel patient on options for voice rehabilitation Patient transitions to adjuvant therapy or surveillance as indicated by the underlying disease YES NO NO

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