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Professional Voice Users Benefit from Nerve Monitoring During Thyroid Surgery

LAS VEGAS, Nev. (May 16, 2014) – Professional voice users ranging from opera singers and rabbi cantors to Motown recording artists and a television meteorologist experienced positive outcomes after undergoing thyroidectomy (surgical removal of all or part of the thyroid gland) using intraoperative monitoring of the vocal cords, according to a benchmark study presented today at the American Association of Clinical Endocrinologists’ (AACE) 23rd Annual Scientific and Clinical Congress.

The study, “Maximal Voice  Preservation in Thyroidectomy Patients,” authored and presented by Gregory Randolph, M.D., F.A.C.S., F.A.C.E., examined vocal outcomes of 30 of his surgical patients, all of whom use their voices professionally. A full 100 percent of the patients returned to performing, with no statistically significant difference between pre-operative and post-operative vocal cord functions.

“We do know that thyroid surgery is associated with nerve injury, vocal cord paralysis or nerve paralysis that can occur in up to 10 percent of thyroidectomies and can lead to voice loss and difficulty swallowing, so these are very, very important complications to avoid,” said Randolph, Director of the Division of General Otolaryngology and the Division of Thyroid and Parathyroid Surgery at Harvard Medical School’s Massachusetts Eye and Ear teaching hospital. “These issues are magnified when you’re dealing with a patient where such complications would not only involve loss of voice, but loss of career.”

Of particular concern, Randolph noted, is potential damage to the recurrent laryngeal nerve, which can result in a paralytic vocal cord, and the external branch of the superior laryngeal nerve, which has specific implications in vocal strength and high registers of the voice often used by professional singers.

Randolph examined a population of his patients – all of whom use their voices in their professions – who underwent thyroid surgery between August 2002 and March 2014 utilizing a technique in which an endotrachial tube (the tube used to assist a patient with breathing while under general anesthesia) is retrofitted with electrodes and utilized during surgery to allow for real-time monitoring electrical activity of the vocal cords and nerves, with the end goal of enhancing the preservation of the nerves’ functional integrity.

He also emphasizes the importance of performing a laryngoscopy – a procedure in which the physician uses a scope to visually examine the back of the throat – prior to and following the surgery.

“By evaluating procedures such as these, we can determine how to improve,” says Randolph, who is working with the American Academy of Otolaryngology (AAO) and the American Head and Neck Society (AHNS) to establish an outcome registry for thyroid and parathyroid surgery. “Ultimately, studies such as this one will allow us to advance the quality of treatment and surgery for patients around the world.”

(Press release by Mary Green, AACE, 407-506-2020)