Evaluation of in PatiVoice Functionents with Recurrent Laryngeal Nerve Injury Following Oncological Endocrine Neck Surgery

Öz

ABSTRACT AIM: Thyroid and parathyroid surgeries are frequently performed in endocrine surgery. Recurrent Laryngeal Nerve (RLS) damage leading to vocal cord paralysis (VCP) is a significant complication in these procedures. This study aims to examine the results of voice therapy and changes in voice parameters in patients who developed RLS damage after total thyroidectomy and lobectomy-parathyroidectomy due to malignancy. MATERIALS AND METHODS: This study was conducted on 39 patients who underwent thyroidectomy or parathyroidectomy between 2021 and 2025 and developed RLS damage and vocal cord paralysis in the postoperative period. These patients received voice therapy once a week for 45 minutes. Maximum phonation duration, S/Z ratio, fundamental frequency, jitter, shimmer, noise-harmonic ratio (NHR), and the Voice Handicap Index (VHI) scale were used to evaluate voice functions. RESULTS: Deterioration in voice parameters was observed in patients during the early postoperative period. In patients undergoing voice therapy, gradual improvement was observed across all acoustic and aerodynamic parameters, with significant increases in MFS values, decreases in the S/Z ratio, and reductions in jitter, shimmer, and NHR values. A decrease in VHI scores over time was observed, indicating improved patients' voice perception. In subsequent follow-up sessions, significant differences were detected in some parameters in the early stages of vocal cord paralysis, while these differences decreased in later sessions. CONCLUSION: It can be said that voice changes developing after vocal cord paralysis (VCP) due to recurrent laryngeal nerve (RLS) injury tend to improve. Postoperative voice therapy and rehabilitation approaches suggest they can contribute to improved voice function. It should be considered that the observed improvement should be evaluated within the context of the natural healing process.

Anahtar Kelimeler

• Thyroid surgery
• vocal cord paralysis
• recurrent laryngeal nerve
• voice analysis
• voice therapy

Destekleyen Kurum

No financial support was received from any institution for this study.

Etik Beyan

This study was approved by the Clinical Research Ethics Committee of Sakarya Training and Research Hospital (Decision No: E.285317, Date: 22.09.2023). The study was conducted in accordance with the Helsinki Declaration.

Teşekkür

Yazarlar, çalışma sağlayan katkı tüm sağlık durumuna ve veri toplama toplamını destekleyen klinik ekibe teşekkür eder.

Onkolojik Endokrin Boyun Cerrahisi Sonrası Rekürren Laringeal Sinir Yaralanması Gelişen Hastalarda Ses Fonksiyonlarının Değerlendirilmesi

Öz

AMAÇ: Tiroid ve paratiroid cerrahileri endokrin cerrahide sıklıkla uygulanmaktadır. Bu girişimlerde Rekürren Laringeal Sinir (RLS) hasarına bağlı vokal kord paralizisi (VKP) önemli bir komplikasyondur. Bu çalışmada malignite nedeniyle total tiroidektomi ve lobektomi-paratiroidektomi sonrası RLS hasarı gelişen hastalarda ses terapisinin sonuçlarını ve ses parametrelerindeki değişimleri incelemeyi amaçlamaktadır GEREÇ VE YÖNTEM: Bu çalışma 2021–2025 yılları arasında tiroidektomi veya paratiroidektomi yapılan hastalarda postoperatif dönemde RLS hasarı ve vokal kord paralizisi gelişen 39 hasta üzerinde gerçekleştirilmiştir. Bu hastalara haftada bir kez, 45 dakika süreyle ses terapisi uygulanmıştır. Ses fonksiyonlarının değerlendirilmesinde maksimum fonasyon süresi, S/Z oranı, temel frekans, jitter, shimmer ve gürültü-harmonik oranı (NHR) ve Voice Handicap Index (VHI) ölçeği kullanılmıştır. BULGULAR: Hastalarda postoperatif erken dönemde ses parametrelerinde bozulma saptanmıştır. Ses terapisi verilerek takip edilen hastalarda tüm akustik ve aerodinamik parametrelerde kademeli iyileşme gözlenmiş olup MFS değerlerinde anlamlı artış, S/Z oranında azalma ve jitter, shimmer ile NHR değerlerinde düşüş izlenmiştir. VHI skorlarında zamanla azalma görülmüş olup, bu durum hastaların ses algısında da iyileşme olduğunu göstermiştir. Takip edilen diğer seanslarda vokal kord paralizi çeşidinde erken dönemde bazı parametrelerde anlamlı farklılıklar saptanırken, ileri seanslarda bu farkların azaldığı gözlenmiştir. SONUÇ: Rekürren laringeal sinir (RLS) hasarına bağlı vokal kord paralizisi (VKP) sonrası gelişen ses değişikliklerinin iyileşme eğiliminde olduğu söylenebilir. Postoperatif dönemde uygulanan ses terapisinin ve rehabilitasyon yaklaşımlarının ses fonksiyonlarının düzelmesine katkı sağlayabileceğini düşündürmektedir. Gözlenen iyileşmenin doğal iyileşme süreci ile değerlendirilmesi gerektiği göz önünde bulundurulmalıdır.

Anahtar Kelimeler

• Tiroid cerrahisi
• vokal kord paralizisi
• rekürren laringeal sinir
• ses analizi
• ses terapisi

Destekleyen Kurum

Bu çalışma için herhangi bir kurumdan finansal destek alınmamıştır.

Etik Beyan

Bu çalışma için Sakarya Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’ndan onay alınmıştır (Karar No: E.285317, Tarih: 22.09.2023). Çalışma Helsinki Bildirgesi’ne uygun olarak yürütülmüştür.

Teşekkür

Yazarlar, çalışmaya katkı sağlayan tüm sağlık personeline ve veri toplama sürecine destek veren klinik ekibe teşekkür eder.

Kaynakça

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