Psychiatric manifestations of the post-thyroidectomy bilateral abductor vocal cord paralysis syndrome. Cases and theoretical issues

[The diagnostics and treatment of bilateral paralysis of the larynx]

The objective of the present study was to consider the currently available methods for the diagnostics and treatment of the patients presenting with bilateral paralysis of the larynx of various etiologies. We undertook the analysis of the publications in the domestic and foreign scientific literature concerning diagnosis and treatment of bilateral paralysis of the larynx. It was found that despite the existing modern high-tech diagnostic technologies and the variety of surgical methods for the treatment of this condition, the problem of diagnostics, management, and rehabilitation of the patients suffering from bilateral paralysis of the larynx remains a serious challenge for the researchers and clinicians that requires further investigation of this pathology. For the correct and timely diagnosis of bilateral paralysis of the larynx, the comprehensive evaluation of the functional state of the neuromuscular apparatus of the larynx is necessary. The key prerequisites for the success of the surgical intervention are its timeliness and the choice of the optimal surgical modalities.

Hoarseness after thyroidectomy: blame the endocrine surgeon alone?

OBJECTIVE

Hoarseness is a postoperative complication of thyroidectomy, mostly due to damage to the recurrent laryngeal nerve (RLN). Hoarseness may also be brought about via vocal cord dysfunction (VCD) due to injury of the vocal cords from manipulations during anesthesia, as well as from psychogenic disorders and respiratory and upper-GI related infections. We reviewed the literature aiming to explore these potential surgical and non-surgical causes of hoarseness beyond thyroidectomy and the role of the endocrine surgeon. Is he/she alone to blame?

METHODS/MATERIAL

The MEDLINE/PubMed database was searched for publications with the medical subject heading "hoarseness" and keywords "thyroidectomy", "RLN", "VCD" or "intubation". We restricted our search till up to May 2013.

RESULTS

In our final review we included 80 articles and abstracts that were accessible and available in English. We demonstrated the incidence of hoarseness stemming from surgical and non-surgical causes and also highlighted the role of intubation as a potential cause of injury-related VCD.

CONCLUSIONS

Hoarseness is a relatively common complication of thyroidectomy, which can be attributed to many factors including surgeon's error or injuries during intubation as well as to other non-surgical causes. However, compared to procedures such as cervical spine surgery, mediastinal surgery, esophagectomy and endarterectomy, thyroidectomy would seem to be a procedure with a relatively low rate of recurrent laryngeal nerve palsies (RLNPs). It is often difficult to determine whether the degree of hoarseness after thyroidectomy should be attributed only the surgical procedure itself or to other causes, for example intubation and extubation maneuvers. The differential diagnosis of postoperative hoarseness requires the use of specific tools, such as stroboscopy and intra- and extralaryngeal electromyography, while methods like acoustic voice analysis, with estimation of maximum phonation time and phonation frequency range, can distinguish between objective and subjective deterioration in the voice. The importance of medical history should be also emphasized.