Head and neck cancers are associated with significant morbidity and mortality despite advancements in treatment in recent decades. A multidisciplinary approach to the treatment of these diseases is thus of essential importance and is becoming the g...

Background: Thyroidectomy, a surgical procedure for thyroid disorders, is associated with postoperative voice changes, even in cases without recurrent laryngeal nerve (RLN) injury. Our study evaluates the prevalence and predictors of voice disorders in thyroidectomy patients without RLN injury. Methods: Our single-center prospective study at the University Hospital Center Zagreb included 243 patients, with pre- and postoperative voice evaluations using acoustic analysis and videostroboscopy. Logistic regression, chi-square, MANOVA, and non-parametric tests assessed the impact of surgical, sociodemographic, and lifestyle factors. Results: The study analyzed 243 participants (141 lobectomy, 102 total thyroidectomy). Postoperative voice disorders occurred in 200 patients (100 lobectomy, 100 total thyroidectomy); 43 (17.7%) experienced no voice disorders. Significant associations were observed for surgery type (χ² = 29.88, p < 0.001), with total thyroidectomy having higher risk, surgery duration (χ² = 16.40, p < 0.001), thyroid volume (χ² = 4.24, p = 0.045), and BMI (χ² = 8.97, p = 0.011). Gender and age showed no significant correlation. Acoustic parameters differed significantly, with lobectomy patients showing better intensity, jitter, and shimmer values across postoperative measurements. Logistic regression identified surgery type (Exp(B) = 16.533, p = 0.001) and thyroid volume (Exp(B) = 2.335, p = 0.023) as predictors of voice disorders, achieving 82.7% classification accuracy. Multivariate analysis confirmed gender and surgery duration as significant contributors. Surgery duration exceeding 90 min and enlarged thyroid volume negatively influenced outcomes. Significant acoustic differences were also linked to BMI categories, with obese participants exhibiting poorer parameters, particularly shimmer and jitter. Conclusions: Surgery type, thyroid volume, BMI, and surgery duration are most likely significant predictors of postoperative voice disorders.

Background and purpose: Endotracheal intubation can carry a risk of mechanical trauma of laryngeal structures. Common postoperative symptoms can include voice changes, vocal fatigue, hoarseness, stridor, sore throat etc. Injuries can be caused by inappropriately chosen endotracheal tube size, longer duration of surgery, type of surgery, and some patient specific factors. The objective of this study is to examine effects of endotracheal intubation and different types of surgery on subjective voice quality measures in different postoperative time points. Also, some patient and operation specific factors will be examined. Material and methods: Study included 80 adult patients, divided into three groups: parotid gland surgery, total thyroidectomy, and abdominal surgery. Sociodemographic data (age, gender, body mass index) were collected. Voice handicap index was used to assess functional, physical, and emotional impact of voice changes to patients’ lives. Anesthesia parameters were collected in the perioperative period. Results: Significant changes in perceived symptoms were detected in all three groups of subjects, in different forms and duration. Perceived symptoms are the longest in patients who underwent total thyroidectomy, while the highest parameters in the first postoperative measurement are in patients who underwent parotid gland surgery. Conclusions: Endotracheal intubation has an impact on perceived voice changes that occur after surgery in the head and neck area. Changes perceived after abdominal surgery were milder and shorter. Patient and surgery related factors have an important impact on intensity and duration of symptoms.

Background/Objectives: Endotracheal intubation can cause postoperative voice disturbances, even after short procedures. These effects have been documented in head and neck surgery, but direct comparisons between head/neck and abdominal surgeries are lacking. We sought to compare short-term postoperative voice changes in patients undergoing head/neck and abdominal surgery and to evaluate their association with intubation parameters and patient factors. Methods: We prospectively studied 80 adults (mean age X ± SD) undergoing either head–neck surgery (parotidectomy or total thyroidectomy) or abdominal surgery. Voice acoustic parameters (fundamental frequency (F₀), jitter, shimmer, intensity, maximum phonation time (MFT)) were measured preoperatively and on postoperative days 2, 14, and 30. Anesthetic parameters were recorded during the perioperative period. Anesthesiologists were blinded to the ongoing investigation. We used repeated-measures ANCOVA (with sex as a covariate) to test for group-by-time interactions and main effects. Effect sizes were calculated. Results: Eighty patients were included. All acoustic parameters showed significant postoperative changes (p < 0.001). The most pronounced alterations occurred in the early postoperative period, with decreased F₀, intensity, and MFT, and increased jitter and shimmer. Significant interaction effects between time and type of surgery were observed for F₀ (ηp² = 0.445), shimmer (ηp² = 0.210), intensity (ηp² = 0.267), and MFT (ηp² = 0.149), indicating distinct recovery patterns across groups. Patients undergoing abdominal surgery showed less pronounced and more rapidly resolving changes, whereas head and neck surgery was associated with greater and more persistent impairment. Among all parameters, shimmer demonstrated the largest overall effect size (ηp² = 0.338), suggesting high sensitivity to short-term voice changes. Perioperative factors, including duration of surgery, endotracheal tube size, and BMI, were significantly associated with the extent of voice changes. Conclusions: Short-duration endotracheal intubation can lead to measurable short-term voice changes, which are more pronounced after head/neck surgery (particularly total thyroidectomy). Objective acoustic analysis detected these subclinical alterations even when patients were asymptomatic. These findings underscore the importance of monitoring voice outcomes and optimizing intubation techniques, although future work is needed to correlate acoustic changes with laryngeal exam findings.

Background and purpose: Thyroidectomies are one of the most common elective surgical procedures in modern medicine. Performed under general anesthesia, thyroidectomies are associated with a high incidence of postoperative nausea and vomiting. Other common complications that increase anxiety among the surgical population are pain, postoperative voice dysfunction, and hypocalcemia. Dexamethasone, as a common adjuvant in anesthesia, is recommended as standard of care for prophylaxis of postoperative nausea and vomiting, as well as in the management of postoperative pain. Recent studies recommended the prophylactic use of dexamethasone in order to prevent hypocalcemia, and voice changes after thyroid surgery. Materials and methods: A literature review with 35 studies included was done to investigate and evaluate the effect of dexamethasone on the postoperative nausea and vomiting, pain, and voice dysfunction in patients undergoing thyroid surgery. Results: Dexamethasone seems to be effective for postoperative nausea and vomiting prophylaxis in patients undergoing thyroid surgery in a preoperative single dose of 8-10 mg intravenously. Dexamethasone may have potential in alleviating pain, but the correct dose needs to be determined. Studies supported the prophylaxis with dexamethasone for voice changes and hypocalcemia, but further research is required. Conclusion: A preoperative single intravenous dose of dexamethasone is a safe and effective method for preventing postoperative nausea and vomiting. Further meta-analyses and high-quality trials are needed to determine the optimal dose for pain relief and to assess its impact on voice changes and hypocalcemia.