Question explored with the scientific record
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What voice therapy protocol is used most often after thyroidectomy paralysis?
The short version: no study in this evidence set tested a voice therapy protocol for post-thyroidectomy paralysis.
The retrieved evidence is almost entirely about surgical prevention and repair of nerve injury—intraoperative monitoring [1, 4, 8], nerve anastomosis [5], thyroplasty [17]—and about risk factors for paralysis [3, 10, 16]. Not one record describes a voice therapy protocol, let alone compares protocols or reports a daily practice dose. The gap is the finding.
The literature on surgical technique for this condition is dense. The literature on voice therapy dosage is absent. No study randomized patients to different practice regimens. No study tracked minutes per day or sessions per week. The most informative design was never run.
My call: the evidence does not support any specific voice therapy protocol for post-thyroidectomy paralysis. Confidence: high that the evidence is absent, not that any protocol is ineffective.
Sources examined 17
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Intraoperative recurrent laryngeal nerve monitoring: a useful method for patients with esophageal cancer
This study investigates the effectiveness of continuous intraoperative recurrent laryngeal nerve monitoring in reducing the incidence of recurrent laryngeal nerve paralysis and improving survival rates in patients undergoing esophagectomy for esophageal cancer.
DOI: 10.1111/j.1442-2050.2012.01414.x -
Fibre Size Frequency in the Recurrent Laryngeal Nerves of Man and Giraffe
This study analyzes the fiber size frequency in the recurrent laryngeal nerves of humans and giraffes, revealing that the left recurrent laryngeal nerve contains a greater number of large, fast-conducting fibers, which may explain the simultaneous arrival of motor impulses to bo…
DOI: 10.3109/00016488109138519 -
Factors Predisposing to Post Thyroidectomy Vocal Cord Paralysis at Ospital ng Maynila Medical Center
A cross-sectional study of 242 thyroidectomy patients found that malignant thyroid lesions had a significantly higher incidence of recurrent laryngeal nerve injury compared to benign lesions, with no significant associations found for other factors.
DOI: 10.32412/pjohns.v38i2.2215 -
Superior laryngeal nerve quantitative intraoperative monitoring is possible in all thyroid surgeries
This study demonstrates that intraoperative neural monitoring can successfully identify the external branch of the superior laryngeal nerve in all thyroid surgeries, providing normative electromyography data and comparing it to the recurrent laryngeal nerve and vagus nerve.
DOI: 10.1002/lary.24446 -
Selective vagus-recurrent laryngeal nerve anastomosis in thyroidectomy with cancer invasion or iatrogenic transection
This study evaluates the effectiveness of selective vagus-recurrent laryngeal nerve anastomosis (SVR) in restoring vocal function in patients undergoing thyroidectomy with recurrent laryngeal nerve injury due to cancer invasion or iatrogenic transection.
DOI: 10.1007/s00423-020-01906-y -
Laryngopharyngeal dysfunction after the Norwood procedure
This study evaluates the incidence and significance of recurrent laryngeal nerve and swallowing dysfunction in neonates after the Norwood procedure compared to those undergoing biventricular aortic arch reconstruction, finding that swallowing dysfunction occurs in 48% of patient…
DOI: 10.1016/j.jtcvs.2005.07.013 -
Reliable Surgical Landmarks for the Identification of the Recurrent Laryngeal Nerve
The letter critiques the study by Çakir et al. on surgical landmarks for identifying the recurrent laryngeal nerve, highlighting variability in nerve anatomy and questioning the accuracy of their findings.
DOI: 10.1016/j.otohns.2007.01.004 -
Anatomical Variations of Recurrent Laryngeal Nerve During Thyroid Surgery: How to Identify and Handle the Variations With Intraoperative Neuromonitoring
This study reviews the anatomical variations of the recurrent laryngeal nerve during thyroid surgery and emphasizes the importance of intraoperative neuromonitoring to prevent nerve injury.
DOI: 10.1016/S1607-551X(10)70089-9 -
A Case of the Non-recurrent Laryngeal Nerve
This study reports a case of a right non-recurrent laryngeal nerve identified during thyroid cancer surgery, highlighting its association with an anomalous origin of the right subclavian artery.
DOI: 10.5631/jibirin.98.229 -
Recurrent Laryngeal Nerve Injury in Thyroid Surgery
This study investigates the risk factors associated with recurrent laryngeal nerve injury during thyroid surgery, revealing significant correlations with factors such as thyroid carcinoma, reoperation for recurrent goiter, and non-identification of the nerve during surgery.
DOI: 10.5001/omj.2011.09 -
Non-recurrent laryngeal nerve
This study reports two cases of a right non-recurrent laryngeal nerve encountered during thyroidectomy, highlighting the anatomical variations and the associated risks of nerve injury during surgery.
DOI: 10.1002/bjs.1800650311 -
Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations
This study evaluates the preservation of recurrent laryngeal nerves during thyroid and parathyroid reoperations, highlighting the techniques used to identify and protect these nerves, and reports minimal postoperative hoarseness among patients.
DOI: 10.1016/S0039-6060(99)70121-2 -
Impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics: An objective multiparameter approach
This study investigates the impact of thyroidectomy without laryngeal nerve injury on vocal quality characteristics using a multiparameter approach, revealing that while there are temporary vocal complaints post-surgery, no permanent changes in vocal quality were observed.
DOI: 10.1002/lary.20762 -
The surgical approach to nodule Thyr 3-4 after the 2.2014 NCCN and 2015 ATA guidelines
A retrospective, single-center analysis of 252 patients with indeterminate thyroid nodules (Bethesda Thyr3/Thyr4) treated from 2013–2016, comparing lobectomy versus total thyroidectomy under NCCN 2.2014 and ATA 2015 guidelines, showing increased use of lobectomy without higher c…
DOI: 10.1016/j.ijsu.2017.05.014 -
Laryngeal vocal and endoscopic alterations after thyroidectomy under local anesthesia and hypnosedation
A prospective study of 35 patients undergoing thyroidectomy under local anesthesia and hypnosedation evaluated vocal function and laryngeal status at one week and 30 days postoperatively using GRBAS, acoustic analysis, videolaryngostroboscopy, and cricothyroid electromyography, …
DOI: 10.1016/s1808-8694(15)30489-4 -
Laryngeal and vocal alterations after thyroidectomy
This study investigates vocal symptoms and acoustic characteristics in patients undergoing thyroidectomy, revealing a significant decrease in dysphonia over time and highlighting the impact of surgical procedures on vocal fold function.
DOI: 10.1016/j.bjorl.2017.08.015 -
Thyroplasty Type I with Ceramic Shim
This study reports the use of hydroxyapatite ceramic shims in Isshiki thyroplasty Type I for unilateral recurrent laryngeal nerve paralysis in 10 patients, showing subjective voice improvement and objective gains (increased MPT and decreased MFR) across shim heights of 4–6 mm, s…
DOI: 10.1111/j.1525-1594.1996.tb04576.x