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Neural-monitored thyroidectomy improves outcomes for professional singers
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Thyroidectomy that uses a neural monitoring system was safe and effective for professional singers with 100% of study participants returning to work within 3 months, according to recent study findings published in Thyroid.
“Thyroidectomy in the professional voice user carries significant risks to livelihood and earning capacity of patients and even has religious consequences in those engaged in religious vocal professions, such as gospel/church singing and Jewish cantors,” the researchers wrote. “This study represents the only publication on vocal outcomes in a consecutive series of professional voice users undergoing thyroid surgery.”
Gregory W. Randolph, MD, FACS, FACE, of Massachusetts Eye and Ear Infirmary and Massachusetts General Hospital, and colleagues evaluated 27 vocal professionals who underwent thyroidectomy — 60% for thyroid cancer — to determine the effect of neural-monitored thyroid surgery on their careers. Researchers analyzed three validated vocal instruments —voice handicap index, singing voice handicap index and evaluation of the ability to sing easily — before and after surgery. Outcomes also included final intraoperative electromyography (EMG) amplitude, time to return to performance and vocal parameters affected.
Sixty-one percent of participants had malignant surgical pathology, whereas 39% were benign. Radioactive iodine treatment was used in 70% of participants with malignancy. Before and after surgery, all participants had normal laryngoscopic exam.
Within a mean time of 2.26 months from surgery to first performance, 100% of participants returned to full professional performance. This period between surgery and first performance was classified as the recovery phase, and all participants had normal speaking voice, as well as normal laryngoscopic examination. Vocal fatigue and high range (both 89%) were the most common vocal parameters affected during the recovery phase, followed by vocal strength (81%), pitch control and modulation (74%), projection (55%), amplitude (52%) and low range (22%).
Vocal training was used by 67% of participants during the recovery phase, and 94% of them reported it was helpful for their return to work.
After surgery, the three vocal instrument scores remained unchanged from baseline.
“We found that neural-monitored thyroidectomy, including for thyroid malignancy, in professional voice users is safe without any changes in three different voice/singing instruments, with 100% return to performance,” Randolph said in a press release. “Intraoperative EMG data at the conclusion of surgery and postoperative laryngeal exam were normal in all patients. Specific vocal parameters are transiently affected during the postoperative recovery phase, which is important to outline in the consent process of this unique patient population and may provide insight into the physiologic state of the larynx subsequent to thyroid surgery.” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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