the Impact of Recurrent Laryngeal Neuromonitoring on Multi-Dimensional Voice Outcomes Following Thyroid Surgery

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Voice changes after thyroidectomy are common but not always related to recurrent laryngeal nerve (RLN) injury. We evaluated if RLN neuromonitoring correlated with non-RLN injury-related changes in voice after thyroidectomy.


Prospective multi-dimensional voice assessment was conducted on patients undergoing thyroidectomy before, 1–4 weeks, and 6 months postoperatively. Voice outcome (VO) was determined as normal (NormVO) or negative (NegVO) based upon combinations of patient-reported symptoms, videolaryngoscopy, a composite of acoustic measurements, and clinician-perceived voice quality. Groups with and without neuromonitoring were compared for early and durable differences in VO.


Ninety-one patients underwent thyroidectomy; 39 with RLN neuromonitoring and 52 without. The two study groups were similar with regard to baseline characteristics including voice assessment. There was no difference in NegVO between neuromonitored and non-monitored patients at 1–4 weeks (n = 89; 32% vs. 27%; P = 0.81) and 6 months (n = 71, 14% vs. 7%; P = 0.42) after thyroidectomy. Neuromonitoring was associated with a 48-min increase in median operative time, but this finding was not statistically significant in a multivariate model.


In this study, recurrent laryngeal neuromonitoring did not appear to influence non-RLN injury related VO as measured by a comprehensive multidimensional voice assessment.

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