Post-thyroidectomy voice and swallowing disorders and association with laryngopharyngeal reflux: A scoping review

Cross-cultural adaptation, reliability, and validity of a Chinese version of the swallowing impairment score

Introduction

The impact of thyroidectomy on swallowing is prevalent. Difficulties in swallowing can lead to malnutrition, destress and a decline in quality of life. The Swallowing Impairment Score (SIS-6) is a uniquely self-evaluation questionnaire aimed at comprehensively assessing the swallowing impairment status in patients after thyroidectomy. However, there is currently no Chinese version available for use among Chinese populations. The objective of this research is to culturally modify the SIS-6 to a Mandarin Chinese version and validate its psychometric features.

Materials and methods

Initially, the SIS-6 was translated and refined; 30 patients who underwent thyroidectomy were enrolled for the cognitive testing. Subsequently, a total of 468 patients who had undergone thyroidectomy were enrolled to evaluate the psychometric properties of the Chinese version.

Results

The Chinese version of SIS-6 was developed through translation and cultural adaptation processes. No floor or ceiling effects were observed. The scale-level Cronbach's α coefficient was 0.790 with each item ranging from 0.404 to 0.665. The scale-level intra-class correlation coefficient was 0.889 with each item ranging from 0.594 to 0.920. The item-level content validity index ranging from 0.880 to 1, with scale-level content validity index of 0.910. The confirmatory factor analysis verified the two-factor structure of the Chinese version of SIS-6 with factor loadings for each item ranging from 0.530 to 0.810.

Conclusion

Although the Mandarin Chinese version of SIS-6 exhibited gender imbalance within its sample size and lacked a cut-off value, it demonstrated satisfactory psychometric properties overall and served as an effective and reliable tool for assessing swallowing difficulties in patients after thyroidectomy.

Hyoid Bone Movement During Swallowing in Female Thyroidectomy Patients: A Kinematic Ultrasound Study

The aim of this study was to investigate the measures of displacement, time and velocity of hyoid bone movement in female thyroidectomy patients. Fifty-eight ultrasound videos of 29 women during swallowing were analyzed. The sample was divided into experimental group (EG), composed of 12 women following total or partial thyroidectomy; and control group (CG) of 17 healthy women. The kinematic measures of displacement, time and velocity of hyoid bone displacement were tracked during swallowing of 10 ml of liquid (water) and 10 ml of thickened liquid (honey) in both groups for comparisons. Additional analysis included bolus consistency effect and relationship with clinical characteristics. Ultrasound videos were analyzed according to a standardized protocol using ImageJ software. Displacement, time and velocity of hyoid movement during swallowing of 10 ml of liquid or thickened liquid were not statistically different between female thyroidectomy patients and healthy women. There is no bolus consistency effect on kinematic measures in both groups, but among thyroidectomy patients, velocity of hyoid bone movement is significantly faster in those with swallowing complaints.

Prevalence of drugs used for chronic conditions after diagnosis of thyroid cancer: a register-based cohort study

OBJECTIVE

Little is known about thyroid cancer survivors' risk of chronic conditions. We, therefore, investigated the prevalence of drugs used for chronic conditions among thyroid cancer patients using population-wide register data.

METHODS

We linked data from the Cancer Registry of Norway to the Norwegian Prescription Database and other databases for a study population of 3.52 million individuals, including 3486 individuals with thyroid cancer diagnosed during 2005-2019. Prevalence ratios (PRs) with 95% CIs of reimbursed prescribed drugs in thyroid cancer patients up to 15 years after thyroid cancer diagnosis were estimated by log-binomial regression, with the cancer-free population as reference.

RESULTS

Individuals (both males and females) with thyroid cancer had higher use of drugs for several chronic conditions in the years after diagnosis; eg, 5 years after thyroid cancer diagnosis, there was elevated use of drugs for hypoparathyroidism (PRmales = 35.4, 95% CI, 25.2-49.7; PRfemales = 42.8, 95% CI, 34.2-53.6), hypertension (PRfemales = 1.20, 95% CI, 1.12-1.28), anxiety and tension (PRmales = 4.01, 95% CI, 1.80-8.92; PRfemales = 2.01, 95% CI, 1.15-3.52), gastric acid disorders (PRmales = 1.52, 95% CI, 1.22-1.91; PRfemales = 1.45, 95% CI, 1.27-1.66), and pain (PRmales = 1.48, 95% CI, 1.11-1.97; PRfemales = 1.24, 95% CI, 1.08-1.42) as compared with the cancer-free population. In addition, males with thyroid cancer had long-term elevated use of drugs for depression (eg, year 10+, PRmales = 1.66, 95% CI, 1.06-2.59). Individuals with thyroid cancer also had higher use of drugs for several conditions prior to the thyroid cancer diagnosis, eg, hypertension, gastric acid disorders, and pain.

CONCLUSIONS

Individuals diagnosed with thyroid cancer had elevated long-term use of drugs for several chronic conditions, as compared with the cancer-free population.

Effects on Voice Quality of Thyroidectomy: A Qualitative and Quantitative Study Using Voice Maps

OBJECTIVES

This study aims to explore the effects of thyroidectomy-a surgical intervention involving the removal of the thyroid gland-on voice quality, as represented by acoustic and electroglottographic measures. Given the thyroid gland's proximity to the inferior and superior laryngeal nerves, thyroidectomy carries a potential risk of affecting vocal function. While earlier studies have documented effects on the voice range, few studies have looked at voice quality after thyroidectomy. Since voice quality effects could manifest in many ways, that a priori are unknown, we wish to apply an exploratory approach that collects many data points from several metrics.

METHODS

A voice-mapping analysis paradigm was applied retrospectively on a corpus of spoken and sung sentences produced by patients who had thyroid surgery. Voice quality changes were assessed objectively for 57 patients prior to surgery and 2months after surgery, by making comparative voice maps, pre- and post-intervention, of six acoustic and electroglottographic (EGG) metrics.

RESULTS

After thyroidectomy, statistically significant changes consistent with a worsening of voice quality were observed in most metrics. For all individual metrics, however, the effect sizes were too small to be clinically relevant. Statistical clustering of the metrics helped to clarify the nature of these changes. While partial thyroidectomy demonstrated greater uniformity than did total thyroidectomy, the type of perioperative damage had no discernible impact on voice quality.

CONCLUSIONS

Changes in voice quality after thyroidectomy were related mostly to increased phonatory instability in both the acoustic and EGG metrics. Clustered voice metrics exhibited a higher correlation to voice complaints than did individual voice metrics.