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

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Abstract


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.

RESULTSPositive 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.


Evgeny L. Choynzonov

Tomsk National Research Medical Center, Russian Academy of Sciences; Siberian State Medical University

Email: choynzonov@tnimc.ru
ORCID iD: 0000-0002-3651-0665
SPIN-code: 2240-8730

Russian Federation, 5, Kooperativny Str., Tomsk, 634009; 2, Moscowski Trakt, Tomsk, 634050

MD, PhD, Professor

Lidiya N. Balatskaya

Tomsk National Research Medical Center, Russian Academy of Sciences

Author for correspondence.
Email: balatskaya@oncology.tomsk.ru
ORCID iD: 0000-0002-2606-661X
SPIN-code: 1894-4904

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

MD, PhD

Sventlana Yu. Chizhevskaya

Tomsk National Research Medical Center, Russian Academy of Sciences

Email: sch@oncology.tomsk.ru
ORCID iD: 0000-0003-2974-4778
SPIN-code: 9561-3382

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

MD, PhD

Olga V. Cheremisina

Tomsk National Research Medical Center, Russian Academy of Sciences

Email: CheremisinaOV@oncology.tomsk.ru
ORCID iD: 0000-0001-7234-4708
SPIN-code: 9579-2691

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

MD, PhD

Elena A. Krasavina

Tomsk National Research Medical Center, Russian Academy of Sciences

Email: krasavinaea@mail2000.ru
ORCID iD: 0000-0002-8553-7039
SPIN-code: 2111-3721

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

PhD

Lilia D. Zhuikova

Tomsk National Research Medical Center, Russian Academy of Sciences

Email: zhuikovalili@mail.ru
ORCID iD: 0000-0003-3536-8473
SPIN-code: 3260-1308

Russian Federation, 2, Moscowski Trakt, Tomsk, 634050

MD, PhD

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Supplementary files

Supplementary Files Action
1. Fig. 1. Paresis of the larynx on the left. The position of the vocal folds when breathing. Before the start of treatment. View (324KB) Indexing metadata
2. Fig. 2. Paresis of the larynx on the left. The position of the vocal folds during phonation. Lateral position of the left vocal fold. Before the start of treatment. View (306KB) Indexing metadata
3. Fig. 3. After the course of voice rehabilitation. Full closure of vocal folds during phonation. View (325KB) Indexing metadata

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Copyright (c) 2019 Choynzonov E.L., Balatskaya L.N., Chizhevskaya S.Y., Cheremisina O.V., Krasavina E.A., Zhuikova L.D.

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