Guidelines for Improving Voice Outcomes Post-Thyroid Surgery

Guidelines for Improving Voice Outcomes Post-Thyroid Surgery

Over the past 30 years, the rates of thyroid surgery have tripled in the United States, according to recent estimates. Studies indicate that between 118,000 and 166,000 patients in the U.S. undergo thyroidectomy each year for benign or malignant disease. The goals of thyroid surgery are to remove abnormal thyroid tissue and any involved lymph nodes, preserve parathyroid gland function, and maintain or improve voice and swallowing. In some cases, however, unintended consequences after these procedures can reduce quality of life. These may include the need for lifelong medication, temporary thyroid suppression, radioactive scanning or treatment, and voice disturbances. Research indicates that voice disturbances occur at least temporarily in up to 80% of patients after they undergo thyroid surgery. About 10% of patients experience voice disturbance directly due to (usually) temporary and (rarely) permanent laryngeal nerve injuries after surgery, with some experiencing voice problems that last for a long time after the procedure. These voice problems include breathiness with loss of air during vocalization, change in pitch, inability to project the voice, and early vocal fatigue, any and all of which can impair communication. “Voice problems after thyroid surgery can significantly reduce quality of life,” says Sujana S. Chandrasekhar, MD. “Surgeons need to realize the importance of evaluating voice in thyroid surgery patients. Early diagnosis and treatment can result in much better outcomes. Physicians should not take a wait-and-see approach.” New Recommendations In 2013, the American Academy of Otolaryngology—Head and Neck Surgery Foundation released a clinical practice guideline that is intended to guide surgeons in using strategies that help minimize voice impairment after thyroid surgery. “Because of the higher...

Overnight Admissions After Younger Pediatric Tonsillectomy

In 1996, the American Academy of Pediatrics and the American Academy of Otolaryngology—Head and Neck Surgery (AAOHNS) released guidelines indicating that children younger than 3 be admitted overnight for postoperative observation. Studies had shown that young patients were at greater risk for postoperative complications that required readmission and inpatient care. Newer surgical techniques for tonsillectomy have helped to decrease the incidence of primary hemorrhage and shorten recovery time. More recent studies looking at complications with tonsillectomy in the very young—in addition to institutional and personal experiences in the operative setting—have caused some clinicians to question the need for overnight admission in these patients. In our experience, many patients who were electively admitted overnight met all of the criteria to be discharged home within 6 hours of their surgery.  A New Retrospective Review of Tonsillectomy More data are needed to establish an evidence-based justification for challenging the longstanding guidelines from AAOHNS. In the March 19, 2012 Archives of Otolaryngology—Head & Neck Surgery, my colleagues and I had a study published in which we retrospectively examined the outcomes of tonsillectomy performed in children under the age of 3. We recorded the complications they experienced. Among the 86 patients whose medical records were reviewed, 80 (93.0%) did not experience any intraoperative or postoperative complications. Complications after tonsillectomies were generally mild and typically linked to dehydration. Our study’s overall complication rate was beneath the 10% ceiling that has been deemed acceptable for ambulatory procedures by some in the field. Results from another study have reinforced our findings. Key Contributors for Success in Young Children Several factors likely contributed to the low rate of...