Prospective trial of voice outcomes after thyroidectomy: evaluation of patient-reported and clinician-determined voice assessments in identifying postthyroidectomy dysphonia.

BACKGROUND: Reliable voice grading systems to identify postoperative voice dysfunction by surgeons are needed.

PURPOSE: To examine the utility of patient-reported and clinician-determined voice assessment in identifying postthyroidectomy voice dysfunction.

PATIENTS AND METHODS: Fifty patients enrolled in a prospective observational trial evaluating voice function perioperatively by patient-reported symptoms (Voice Case History [VCHx]) and perceived voice handicap (Voice Handicap Index [VHI]), clinician-determined judgment of voice quality (Consensus Auditory-Perceptual Evaluation--Voice [CAPE-V]), and laryngeal examination via video laryngoscopy (VLS). Voice dysfunction at first postoperative visit in symptomatic patients was defined by objective laryngeal abnormalities on VLS. Postoperative changes from baseline in voice parameters were compared between patients with and without voice dysfunction using the Wilcoxon rank sum test. Receiver operating characteristics were evaluated to determine area under the curve (AUC) for tested parameters.

RESULTS: Eight (16%) had early transient and 1 (2%) had permanent postoperative voice dysfunction. VCHx symptoms had negative (NPV) and positive (PPV) predictive values of 96%-100% and 39%-53%, respectively for voice dysfunction. The rating of overall severity from the CAPE-V was highly predictive (AUC = 0.96), and a change in severity from preoperative baseline >or=20% at 1-2 weeks had a PPV of 86% and NPV of 95% for postoperative dysphonia. Patient-reported total VHI score was most predictive (AUC = 0.97) and a change in VHI from preoperative baseline >or=25 early postoperatively had a PPV of 88% and NPV of 97% for postoperative dysphonia.

CONCLUSION: Patient self-assessment of voice handicap using the VHI reliably identifies voice dysfunction after thyroidectomy. Patients with a change in VHI >or=25 from preoperative baseline warrant early referral to speech pathology and laryngology.