Selective Laryngeal Examination

Sensitivity of Endocrine Surgeons in Screening Voice Abnormality

Research output: Contribution to journalArticle

Abstract

Objectives: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries. Design and Setting: Descriptive cross-sectional study in a tertiary center. Participants and Methods: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience. Main outcome measures: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects’ acoustic analysis and Voice Handicap Index (VHI-10) were analyzed. Results: Raters A, B, and C have sensitivity of 63.6%, 78.8%, and 66.7%, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8% and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2%, 71.2%, and 72.7%, respectively. Conclusions: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.

Original languageEnglish
JournalJournal of Voice
DOIs
Publication statusAccepted/In press - 1 Jan 2019

Fingerprint

Vocal Cord Paralysis
Laryngeal Nerves
Thyroid Gland
Thyroidectomy
Acoustics
Neck
Surgeons
Parathyroidectomy
Noise
Thorax
Cross-Sectional Studies
Outcome Assessment (Health Care)
Sensitivity and Specificity

Keywords

  • Acoustics
  • Endoscopy
  • Larynx
  • Vocal cords
  • Voice

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Speech and Hearing
  • LPN and LVN

Cite this

@article{e201337ef4ee4b06a388a2d4131e65c4,
title = "Selective Laryngeal Examination: Sensitivity of Endocrine Surgeons in Screening Voice Abnormality",
abstract = "Objectives: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries. Design and Setting: Descriptive cross-sectional study in a tertiary center. Participants and Methods: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience. Main outcome measures: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects’ acoustic analysis and Voice Handicap Index (VHI-10) were analyzed. Results: Raters A, B, and C have sensitivity of 63.6{\%}, 78.8{\%}, and 66.7{\%}, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8{\%} and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2{\%}, 71.2{\%}, and 72.7{\%}, respectively. Conclusions: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.",
keywords = "Acoustics, Endoscopy, Larynx, Vocal cords, Voice",
author = "Al-Yahya, {Syarifah N.} and Rohaizak Muhammad and {Abdullah Suhaimi}, {Shahrun Niza} and Mawaddah Azman and Mohamed, {Abdullah Sani} and {Mat Baki}, Marina",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jvoice.2018.12.003",
language = "English",
journal = "Journal of Voice",
issn = "0892-1997",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Selective Laryngeal Examination

T2 - Sensitivity of Endocrine Surgeons in Screening Voice Abnormality

AU - Al-Yahya, Syarifah N.

AU - Muhammad, Rohaizak

AU - Abdullah Suhaimi, Shahrun Niza

AU - Azman, Mawaddah

AU - Mohamed, Abdullah Sani

AU - Mat Baki, Marina

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries. Design and Setting: Descriptive cross-sectional study in a tertiary center. Participants and Methods: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience. Main outcome measures: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects’ acoustic analysis and Voice Handicap Index (VHI-10) were analyzed. Results: Raters A, B, and C have sensitivity of 63.6%, 78.8%, and 66.7%, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8% and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2%, 71.2%, and 72.7%, respectively. Conclusions: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.

AB - Objectives: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries. Design and Setting: Descriptive cross-sectional study in a tertiary center. Participants and Methods: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience. Main outcome measures: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects’ acoustic analysis and Voice Handicap Index (VHI-10) were analyzed. Results: Raters A, B, and C have sensitivity of 63.6%, 78.8%, and 66.7%, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8% and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2%, 71.2%, and 72.7%, respectively. Conclusions: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.

KW - Acoustics

KW - Endoscopy

KW - Larynx

KW - Vocal cords

KW - Voice

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DO - 10.1016/j.jvoice.2018.12.003

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