Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery

Ann Otol Rhinol Laryngol. 2019 Dec;128(12):1104-1110. doi: 10.1177/0003489419858629. Epub 2019 Jul 11.


Objectives: This study is set to analyze clinicopathological factors predicting the recovery of unilateral vocal fold paralysis (UVP) in patients after thyroid gland surgery. The quality of voice was additionally assessed in these patients.

Methods: The charts and videolaryngostroboscopy (VLS) examinations of 84 consecutive patients with a complete UVP after surgery of the thyroid gland were retrospectively reviewed. Patients were divided into 2 groups: patients who fully recovered from vocal fold paralysis and those who failed to recover after a follow-up of 12 months. The quality of voice was analyzed among other things by determining the Voice Handicap Index (VHI).

Results: The UVP fully recovered in 52 of 84 (61.9%) patients. Positive mucosal waves (pMWs) on the paralyzed side, a minimal glottic gap <3 mm seen at the first postoperative VLS, age ≤50 years, and surgery duration ≤120 minutes were associated factors for a complete recovery of nerve function. The voice parameters improved independently from recovery of the paralysis in 90% of the patients.

Conclusions: For patients with a poor prognosis of a UVP, early intervention may be beneficial. Thus, predicting factors for a full recovery of vocal fold motion would be a valuable tool. In our cohort, about 60% of recoveries could have been predicted using the above-mentioned parameters. Good quality of voice was independently reached in 90% of the cases.

Keywords: Laryngology; Otolaryngology; mucosal wave; recovery; thyroid surgery; videolaryngostroboscopy; vocal cord palsy.

MeSH terms

  • Adult
  • Age Factors
  • Female
  • Humans
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Complications / etiology
  • Postoperative Complications / pathology
  • Postoperative Complications / physiopathology*
  • Prognosis
  • Recovery of Function*
  • Retrospective Studies
  • Thyroidectomy / adverse effects*
  • Vocal Cord Paralysis / etiology
  • Vocal Cord Paralysis / pathology
  • Vocal Cord Paralysis / physiopathology*
  • Voice Quality*