Professionals Singers Return to Performance on Average 2 Months after Thyroid Surgery

Professional female singer, vocalistCommentary by Gregory W. Randolph, MD

In the first study of its kind, researchers found that all 27 consecutive professional voice users (including professional operatic performers) who underwent neural monitored thyroid surgery were able to return to performance, researchers reported in a recent issue of Thyroid. The mean time to performance return was 2.26 months.

“A major part of the success in management of these difficult patients was clearly the use of neural monitoring,” explained senior author Gregory W. Randolph, MD, the Claire and John Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School and Director, Division of Thyroid and Parathyroid Surgery, at Massachusetts Eye and Ear Infirmary, Boston, Massachusetts.

All the patients showed normal intraoperative electromyography data at the end of surgery and postoperative laryngeal exam results. In addition, all patients showed excellent results on 3 validated vocal instruments postsurgery, Dr. Randolph said.

How Vocal Cord Injury May Occur During Thyroid Surgery
“Most of the muscles in the vocal cord are innervated by the left and right recurrent laryngeal nerves, which are located directly adjacent to the thyroid gland,” Dr. Randolph told EndocrineWeb. “If the nerve is altered (ie, cut or stretched) during surgery, then the voice becomes like a whisper and swallowing may be impacted. The rate at which the nerve is injured, can be as high as 10%, and many of these injuries may last weeks, months or be permanent,” Dr. Randolph said.

“Another much smaller nerve located at each side of the larynx or voice box near the thyroid—the external branch of the superior laryngeal nerve—innervates one isolated muscle of the larynx that regulates higher pitches and vocal projection, which are of extreme importance to the voice of a professional singer,” Dr. Randolph said.

For a singer or other voice professional, “injury to any of these nerves can engender voice changes that, if definitive and permanent, can be career threatening or career ending,” Dr. Randolph said. “I have focused my practice on the identification and preservation those nerves, and part of that work has focused on development of an intraoperative neural monitoring system that allows us to electrically test the nerves during surgery to determine their position and health during surgery,” he said.

Vocal Parameters Temporarily Affected by Surgery
“Even when the results are ultimately favorable, surgery still brings about transient changes to the larynx and the vocal cords,” Dr. Randolph noted. In the study, the vocal parameters that were most affected during the recovery phase were vocal fatigue (89%), high range (89%), pitch control and modulation (74%), and strength (81%).

“These findings are helpful when counseling both professional voice users and other patients about what changes may occur during that recovery phase,” Dr. Randolph noted.

August 27, 2015

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