AAO-HNS GUIDELINES Bundle (free trial)

Improving Voice Outcomes after Thyroid Surgery

American Academy of Otolaryngology-Head and Neck Surgery Foundation GUIDELINES Apps brought to you free pf charge, courtesy of Guideline Central. Enjoy!

Issue link: https://eguideline.guidelinecentral.com/i/369961

Contents of this Issue

Navigation

Page 4 of 9

Table 2. Discussion Points for the Surgeon/Patient Educator Preoperative discussions Surgeon should inquire if the patient has had any voice change or hoarseness prior to surgical intervention. Surgeon/educator should complete a voice assessment preoperatively. Surgeon/educator should discuss with patient the risk factors for voice change following thyroid surgery. For example, in patients with a large multinodular goiter, known extra- thyroidal extension or re-operation in an area of previous neck surgery, thyroidectomy may increase the risk of voice change. Surgeon/educator should discuss with the patient possible surgical risks as they relate to the potential for voice change following thyroidectomy. ese risks may include injury to the RLN, EBSLN, from division of the strap muscles, and potential intubation trauma. Surgeon/educator should discuss the potential benefits and need for preoperative laryngoscopy. Surgeons who use intraoperative nerve monitoring should discuss with patients the rationale for use and the potential that second side surgery might not be completed in planned bilateral cases based on information gained from monitoring. Postoperative discussions Patients should be instructed to notify their providers if voice change (breathiness, hoarseness, decreased exercise tolerance, or increased vocal effort) lasts for >2 weeks. Patients should have an assessment of their voice postoperatively. Patients should be counseled that there are techniques to potentially improve voice, if necessary, following thyroid surgery and that early recognition of persistent voice change is important to success. Table 3. Preoperative Factors that May Be Associated with Extrathyroidal Extension in Patients with a Preoperative Diagnosis of Thyroid Malignancy Historical factors: voice abnormality, dysphagia, airway symptoms, hemoptysis, pain, rapid progression Physical exam factors: large or firm mass, mass fixed to the larynx or trachea Radiographic factors a (typically ultrasound and/or CT or MR): irregular or blurred borders or extension of the mass to the periphery of a thyroid lobe, especially posterior extension a Note: imaging studies may be negative for invasion in patients with extrathyroidal extension.

Articles in this issue

Archives of this issue

view archives of AAO-HNS GUIDELINES Bundle (free trial) - Improving Voice Outcomes after Thyroid Surgery