Voice rehabilitation of patients with unilateral laryngeal paresis after thyroid cancer surgery

BACKGROUND: Recurrent laryngeal nerve injury is one of the most frequent complications of surgery for thyroid cancer. This injury may result in vocal cord paresis and respiratory failure. Repeat surgery for recurrent tumors involves increased risk of recurrent nerves paresis.

AIM: to evaluate the efficacy of voice rehabilitation in patients with unilateral laryngeal paresis after surgery for thyroid cancer.

MATERIAL AND METHODS: Between 2008 and 2017, a total of 54 patients with unilateral laryngeal nerve paralysis after surgery for thyroid cancer were treated at the Cancer Research Institute. All patients had histologically verified advanced stage (T3–4N0–2M0–1) of thyroid cancer. Papillary thyroid cancer was diagnosed in 87% cases. Endoscopic or laryngoscopic examination and acoustic voice analysis were the criteria for assessing voice rehabilitation efficacy.

RESULTS: Positive outcomes of voice rehabilitation were obtained in 54 patients. The vocal fold mobility was completely restored in 36 (67%) patients. The voice function was recovered due to the compensation provided by the healthy half of the larynx in 11 (21%) patients. In 7 (12%) patients, the vocal sound improved, patients no longer complained of . speech fatigue, but hoarseness persisted. By the time of discharge, the patients were able to go back to work. The effectiveness of voice restoration in patients with unilateral laryngeal paresis was directly dependent on the early start of rehabilitation measures (5–7 days after surgery) subject to interdisciplinary approach. The voice rehabilitation course ranged from 3 to 6 weeks.

CONCLUSIONS: Our technique of voice rehabilitation in patients with unilateral laryngeal paresis after surgery for thyroid cancer shortened the rehabilitation time, reduced disability in oncological patients practicing voice and speech professions and improved the quality of life and social adaptation of these patients.

thyroid cancer, surgical treatment, complications, laryngeal paresis, voice rehabilitation

1. Пачес А.И. Опухоли головы и шеи. Клиническое руководство. 5-е изд. — М.: Практическая Медицина, 2013. [Paches АI. Opukholi golovy i shei. ClinicalgGuidelines. 5th Ed. Мoscow: Prakticheskaya Meditsina, 2013. (In Russ.)].

2. Эндокринная хирургия. / Под ред. Дедова И.И., Кузнецова Н.С., Мельниченко Г.А. — М.: Литтерра, 2014. [Dedov II, Kuznetsov NS, Melnichenko GA, Editors. Engokrinnaya Khirurgiya. Moscow: Litterra, 2014. (In Russ.)].

3. Романчишен А.Ф. Хирургия щитовидной и околощитовидных желез. — СПб: Вести, 2009. [Romanchishen AF. Khirurgiya shchitovidnoy i okoloshchitovidnykh zhelez. Saint-Petersburg: Vesti, 2009. (In Russ.)].

4. Чижевская С.Ю. Эффективность нейтронной и нейтронно-фотонной терапии местно-распространенных злокачественных новообразований головы и шеи: Дис. … канд. мед. наук. — Томск. 2000. [Chizhevskaya SYu. Effektivnost’ neytronnoy i neytronno-fotonnoy terapii mestno-rasprostranennykh zlokachestvennykh novo obrazovaniy golovy i shei. [Dissertation]. Tomsk. 2000. (In Russ.)].

5. Ветшев П.С., Карпова О.Ю., Чилингариди К.Е. Профилактика и лечение нарушений подвижности голосовых складок при операциях на щитовидной железе. // Хирургия. — 2005. — № 10. — С. 28-34. [Vetshev PS, Karpova OYu, Chilingaridi KE. Profilaktika i lechenie narusheniy podvizhnosti golosovykh skladok pri operatsiyakh na shchitovidnoy zheleze. Khirurgiia (Mosk). 2005;(10):28-34. (In Russ.)].

6. Румянцев П.О. Интраоперационный нейромониторинг при операциях на щитовидной железе. // Эндокринная Хирургия. — 2012. — Т. 6. — № 2. — C. 42-47. [Rumyantsev PO. Intraoperative neuromonitoring in thyroid surgery. Endocrine Surgery. 2012;6(2):42-47. (In Russ.)]. doi: https://doi.org/10.14341/2306-3513-2012-2-42-47

7. Bron LP, O’brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg. 2004;91(5):569-574. doi: https://doi.org/10.1002/bjs.4507

8. Ardito G, Revelli L, D’alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves. Am J Surg. 2004;187(2):249-253. doi: https://doi.org/10.1016/j.amjsurg.2003.11.001

9. Семке В.Я., Чойнзонов Е.Л., Куприянова И.Е., Балацкая Л.Н. Развитие cибирской психоонкологии. — Томск: Издательство Томского университета, 2008. [Semke VYa, Choynzonov EL, Kupriyanova IE, Balatskaya LN. Razvitie Sibirskoy Psikhoonkologii. Tomsk: Izdatel’stvo Tomskogo Universiteta. 2008. (In Russ.)].

10. Степанова Ю.Е., Готовяхина Т.В., Мохотаева М.В., Махоткина Н.Н. Комплексная реабилитация пациентов с односторонним парезом гортани после хирургического вмешательства на щитовидной железе (медико-педагогические рекомендации). // Российская Оториноларингология. — 2014. — № 4. — С. 131-137. [Stepanova YuE, Gotovyakhina TV, Mokhotaeva MV, Makhotkina NN. Complex rehabilitation of patients with unilateral vocal fold paresis after thyroid surgery (medical and pedagogical recommendations). Russian Otorhinolaryngology. 2014;(4):131-137. (In Russ.)].

11. Василенко Ю.С. Голос. Фониатрические Аспекты. — М.: Дипак, 2013. [Vаsilenko YuS. Golos. Foniatricheskie Aspekty. Moscow: Dipak; 2013. (In Russ.)].

12. Свидетельство о государственной регистрации программы для ЭВМ №2015618857/19.08.15. Харченко С.С., Мещеряков Р.В., Вольф Д.А., и др. Программа речевой реабилитации больных после резекции гортани. [Certificate of state registration of the computer program №2015618857/19.08.15. Kharchenko SS, Meshcheryakov RV, Wolf DA, et al. Programma rechevoy reabilitatsii bol’nykh posle rezektsii gortani. (In Russ.)].

13. Харченко С.С., Мещеряков Р.В., Вольф Д.А., и др. Программный комплекс речевой реабилитации онкологических больных после резекции гортани. // Медицинская Техника. — 2016. — № 2. — С. 51-55. [Kharchenko SS, Meshcheryakov RV, Wolf DA, et al. Software for speech rehabilitation of cancer patients after larynx resection. Med Tekh. 2016;(2):51-55. (In Russ.)].