Patient Perception of Swallowing after Thyroidectomy in the Absence of Laryngeal Nerve Injury.

INTRODUCTION: Swallowing and voice alterations may manifest in patients with thyroid disease, especially after thyroidectomy. OBJECTIVE: To identify the prevalence of patients with complaints of swallowing disorders after thyroidectomy and to evaluate patients' perceptions regarding swallowing before and after the procedure. METHODS: A prospective longitudinal study was performed with 26 consecutive patients undergoing a private service thyroidectomy, in which the presence of swallowing dysfunction was evaluated using validated questionnaires that addressed the perception of swallowing by patients before (on the day of surgery) and after the surgery (on the first postoperative day). RESULTS: Of the 26 patients, 18 (69.2%) were subjected to total thyroidectomy and 8 to partial thyroidectomy. Analysis of the domains of the Swallowing Handicap Index questionnaire showed higher scores when evaluated on the first postoperative day, demonstrating a significant worsening in swallowing after the procedure. The same result was demonstrated for the final score of swallowing perception, with 15.3 and 30.8% of patients reporting moderate alterations before and after the thyroidectomy, respectively, and 11.5% reporting the alterations as severe. Swallowing and vocal symptoms on the first postoperative day were more prevalent in the procedure than previously mentioned. Eight patients (30.8%) noted swallowing alterations before the procedure, compared with 80.8% (21 cases) after thyroidectomy. CONCLUSION: There was a prevalence of 42.3% in swallowing complaints on the first postoperative day, regardless of the lesion in the laryngeal innervation, and this prevalence was significantly higher than that prior to the procedure.

Incidência de alterações da mobilidade das pregas vocais após tratamentos de bócios ou tumores / Incidence of changes in vocal fold mobility after treatments of goiters or tumors

Objetivo: Estabelecer a incidência de alterações da mobilidade das pregas vocais, a presença de alterações funcionais como disfonia e/ou disfagia e a aderência ao tratamento fonoaudiológico em pacientes submetidos ao tratamento de bócios ou tumores de tireóide, parótida, esôfago, pulmão e/ou mama. Avaliar os fatores de risco para ocorrência de alterações da mobilidade das pregas vocais no grupo de tireoidectomizados. Material e Método: Estudos retrospectivos, realizados no Centro de Tratamento e Pesquisa Hospital do Câncer A.C. Camargo, em São Paulo, Brasil entre janeiro de 1990 e julho de 2001 com 1450 pacientes submetidos ao tratamento de bócios ou tumores de tireóide, parótida, esôfago, pulmão e/ou mama (estudo 1) e 1 022 pacientes submetidos à tireoidectomia (estudo 2). Resultados: No estudo 1 foi constatado disfonia em 4,5% dos pacientes e disfagia em 3,5%. As alterações da mobilidade das pregas vocais foram constatadas em 8,3% dos pacientes (excluindo-se os pacientes de mama). O tratamento fonoaudiológico foi realizado em 65% dos 66 pacientes com alterações funcionais. No estudo 2 constatou-se incidência de alterações da mobilidade das pregas vocais em 1,8% dos pacientes, dos quais todos tinham disfonia e 350/fJ disfagia, sendo 78% submetidos ao tratamento fonoaudiológico. Conclusão: Tratamento de bócios ou tumores de tireóide, parótida, esôfago, pulmão e/ou mama podem acarretar alterações vocais e/ou de deglutição, independente da alteração da mobilidade das pregas vocais. A experiência do cirurgião, tipo de lesão, idade do paciente não foram constatadas como fatores de risco nas tireoidectomias. Este estudo sugere a necessidade da atuação multidisciplinar na abordagem do paciente oncológico

Objective: To assess the incidence ofthe dysfunctions ofthe mobility ofthe vocal folds, 7 dysphonia, dysphagia and compliance to speech treatment in patients submitted to treatment of goiters or tumors ofthe thyroid, parotid" esophagus, lung and/or breast. To evaluate the risk factors for dysfunctions of the mobility of the vocal folds in the group with the thyroidectomy. Material and Method: Retrospective studies accomplished in the Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo in São Paulo, Brazil between January 1990 and July 2001 with 1450 patient submitted to treatment of goiters or tumors of the thyroid, parotid, esophagus, lung and/or breast (study 1) and 1022 patients submitted to thyroidectomy. (study 2). Results: In the study 1 dysphonia occurred in 4.5% patients and dysphagia occurred in 3.5%. The dysfunctions of the mobility ofthe vocal folds were verified in 8.3o/o patients (excluded breast patients). The speech treatment was accomplished in 65% of66 the patients with functional alterations. In the study 2 the incidence of the dysfunctíon of the mobility of the vocal folds occurred in 1.8% patients, ali of them with dysphonia, 35°/o wíth dysphagia and 78% were submitted to speech treatment Conclusion: The treatment of goiters or tumors o f the thyroid, parotid, esophagus, lung and/or breast can result in abnormalites of v o ice and swallowing, independent o f the dysfunction o f the mobility o f the vocal folds. The surgeon's experience, lesion type, the patient's age were not risk factors in patients underwent thyroidectomy. This study suggest the need of the multidisciplinary in the approach ofthe oncology patient