Guideline

. 2022 Feb;15(1):24-48.

doi: 10.21053/ceo.2021.00633. Epub 2021 Jun 1.

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force; Chang Hwan Ryu¹, Seung Jin Lee², Jae-Gu Cho³, Ik Joon Choi⁴, Yoon Seok Choi⁵, Yong Tae Hong⁶, Soo Yeon Jung⁷, Ji Won Kim⁸, Doh Young Lee⁹, Dong Kun Lee¹⁰, GIljoon Lee¹¹, Sang Joon Lee¹², Young Chan Lee¹³, Yong Sang Lee¹⁴, Inn Chul Nam¹⁵, Ki Nam Park¹⁶, Young Min Park¹⁷, Eui-Suk Sung¹⁸, Hee Young Son¹⁹, In Hyo Seo²⁰, Byung-Joo Lee^{18

21}, Jae-Yol Lim¹⁷

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea.
² Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea.
³ Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University, School of Medicine, Daegu, Korea.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.
¹³ Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
¹⁴ Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹⁵ Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Dongnam Institute Of Radiological and Medical Sciences, Busan, Korea.
²⁰ Voice and Speech Clinic, Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.
²¹ Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

PMID: 34098629
PMCID: PMC8901944
DOI: 10.21053/ceo.2021.00633

Guideline

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force et al. Clin Exp Otorhinolaryngol. 2022 Feb.

. 2022 Feb;15(1):24-48.

doi: 10.21053/ceo.2021.00633. Epub 2021 Jun 1.

Authors

Affiliations

¹ Department of Otorhinolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea.
² Division of Speech Pathology and Audiology, Research Institute of Audiology and Speech Pathology, College of Natural Sciences, Hallym University, Chuncheon, Korea.
³ Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea.
⁴ Department of Otorhinolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea.
⁵ Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Daegu, Korea.
⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Korea.
⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Inha University College of Medicine, Incheon, Korea.
⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁰ Department of Otorhinolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea.
¹¹ Department of Otorhinolaryngology-Head and Neck Surgery, Kyungpook National University, School of Medicine, Daegu, Korea.
¹² Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.
¹³ Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea.
¹⁴ Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹⁵ Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹⁶ Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea.
¹⁷ Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹⁸ Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea.
¹⁹ Department of Otorhinolaryngology-Head and Neck Surgery, Dongnam Institute Of Radiological and Medical Sciences, Busan, Korea.
²⁰ Voice and Speech Clinic, Department of Otorhinolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea.
²¹ Biomedical Research Institute, Pusan National University Hospital, Busan, Korea.

PMID: 34098629
PMCID: PMC8901944
DOI: 10.21053/ceo.2021.00633

Abstract

Voice change is a common complaint after thyroid surgery and has a significant impact on quality of life. The Korean Society of Laryngology, Phoniatrics and Logopedics assembled a task force to establish guideline recommendations on education, care, and management related to thyroid surgery. The guideline recommendations encompass preoperative voice education, management of anticipated voice change during surgery, and comprehensive voice care after thyroid surgery, and include in-depth information and up-to-date knowledge based on validated literature. The committee constructed 14 key questions (KQs) in three categories-preoperative (KQ 1-2), intraoperative (KQ 3-8), and postoperative (KQ 9-14) management-and developed 18 evidence-based recommendations. The Delphi survey reached an agreement on each recommendation. A detailed evidence profile is presented for each recommendation. The level of evidence for each recommendation was classified as high-quality, moderate-quality, or low-quality. The strength of each recommendation was designated as strong or weak considering the level of evidence supporting the recommendation. The guidelines are primarily targeted toward physicians who treat thyroid surgery patients and speech-language pathologists participating in patient care. These guidelines will also help primary care physicians, nurses, healthcare policymakers, and patients improve their understanding of voice changes and voice care after thyroid surgery.

Keywords: Dysphonia; Guideline; Thyroid Neoplasms; Thyroidectomy; Voice.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

**Fig. 1.**
Flow diagram for the literature search. KQ, key question; SLN, superior laryngeal nerve; RLN, recurrent laryngeal nerve; IONM, intraoperative neuromonitoring; VFP, vocal fold paralysis.

**Fig. 2.**
Voice education after thyroid surgery.

**Fig. 3.**
(A-D) Neck exercise after thyroid surgery.

**Fig. 4.**
(A, B) Laryngeal massage after thyroid surgery.

**Fig. 5.**
(A-C) Neck posture adjustments after thyroid surgery.

**Fig. 6.**
Flowchart for the care and management of voice change after thyroid surgery. KQ, key question; VAS, visual analog scale; GRBAS, Grade, Roughness, Breathiness, Asthenia, and Strain; VHI, Voice Handicap Index; IONM, intraoperative neuromonitoring; EBSLN, external branch of the superior laryngeal nerve; RLN, recurrent laryngeal nerve; MPT, maximum phona- tion time; MDVP, Multi-Dimensional Voice Program; VRP, voice range profile; CPP, cepstral peak prominence; VFP, vocal fold paralysis.

See this image and copyright information in PMC

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Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

Affiliations

Care and Management of Voice Change in Thyroid Surgery: Korean Society of Laryngology, Phoniatrics and Logopedics Clinical Practice Guideline

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