Subject(s)
Glottis/surgery , Polytetrafluoroethylene , Prosthesis Implantation , Thyroid Cartilage/surgery , Vocal Cord Paralysis/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Anesthesia, Local , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Phonation/physiology , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Sound Spectrography , Voice Quality/physiology , Young AdultABSTRACT
A review of a combined gastroenterology and laryngology clinic was conducted to determine the effectiveness of treatment and the predictive value of clinical findings and investigations. Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngopharyngeal reflux (based on a positive oesophageal pH test and/or changes on videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months. There were 87 patients; the most common symptoms were cough (38 per cent) and hoarseness (36 per cent); 77 per cent had some symptoms suggestive of gastro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per cent). The presence of reflux symptoms was not a predictor of a good response. Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correlation, p = 0.01). Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between improvement in laryngitis (after treatment) and improvement in symptoms (p = 0.08). The response to proton pump inhibitors was lower than other published results. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the decision to treat with anti-secretory therapy, based only on the presence of posterior laryngitis.
Subject(s)
Anti-Ulcer Agents/administration & dosage , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , Laryngeal Diseases/diagnosis , Laryngeal Diseases/drug therapy , Omeprazole/administration & dosage , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/drug therapy , Clinical Protocols , Diagnosis, Differential , Female , Humans , Laryngitis/complications , Laryngoscopy/methods , Male , Middle Aged , Prospective StudiesABSTRACT
BACKGROUND: Vocal dysfunction in patients with thyroid pathology has been poorly documented, and dysfunction after thyroid surgery is generally reported in terms of recurrent laryngeal nerve or external laryngeal nerve palsy. But voice dysfunction is more complex than simply nerve integrity. The present study reports the incidence of dysphonia in patients presenting for thyroid surgery, and relates postoperative changes in vocal function to recurrent and external laryngeal nerve function, and the surgical handling of the strap muscles. METHODS: Fifty patients were assessed by Visipitch before and after thyroidectomy. Following surgery the patients filled out a questionnaire. RESULTS: Overall 26 of 44 patients had no subjective postoperative voice change, while 10 reported subjective deterioration and eight reported subjective improvement in voicing. Postoperative objective assessment of these patients found that 17 were the same, eight refused to come for testing because they felt their voice had not changed, 13 were better and six were worse. Following surgery two patients (4.5%) had temporary recurrent laryngeal nerve palsies (2.5% of nerves at risk), and four patients (10%) suffered external laryngeal nerve palsies. Division of strap muscles was not detrimental to voicing. Six patients were lost to follow-up. Fifteen patients (34%) presented with vocal abnormalities, six (40%) of whom improved postoperatively. CONCLUSIONS: Patients may have voicing abnormalities before thyroid surgery is performed. Surgery may improve or worsen the voice irrespective of the pre-operative voice status.
