How Can We Screen Voice Problems Effectively in Patients Undergoing Thyroid Surgery?

Abstract

Objectives:

We designed this study to develop an efficient and cost-effective screening tool for detecting voice disorders following thyroidectomy.

Methods:

We developed the Perioperative Voice-Screening Protocol for Thyroid Surgery (PVST) using the Thyroidectomy-Related Voice Questionnaire (TVQ) to provide a cost-effective diagnostic flow sheet for patients following thyroidectomy. The TVQ is a simple questionnaire that was developed at our institution and has already demonstrated its effectiveness in detecting pre- and post-thyroidectomy voice-related disorders in our previous studies. To investigate the PVST, we enrolled 242 subjects who underwent thyroidectomy and let them follow the PVST. All subjects underwent a voice work-up by a voice specialist to verify the predictive value of the protocol.

Results:

Using PVST, we could effectively screen for abnormal preoperative laryngeal findings with a sensitivity and specificity of 82.1% and 50.5%, respectively, especially laryngeal benign mucosal disease with a sensitivity and specificity of 100% and 45.6%, respectively. We could also screen for postoperative voice-related problems with a sensitivity and specificity of 100% and 50.4% for detecting vocal cord palsy, and 66.7% and 51.2% for detecting a low-pitched voice, respectively. When all 242 patients followed the protocol, US $42,768 would be saved, and the PVST was estimated to decrease costs by 43.5%.

Conclusions:

The PVST is a reliable and cost-effective perioperative screening tool that enables thyroid surgeons to detect patients with voice problems in their routine outpatient clinic for early and appropriate referral to voice specialists.