피대근절개에따른갑상선절제술후의음성변화. Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy 김영모 1 조정일 1 김철호 1 박정선 1 최호순 3 하현령 2

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1 KISEP Head and Neck Korean J Otolaryngol 2000;43: 피대근절개에따른갑상선절제술후의음성변화 김영모 1 조정일 1 김철호 1 박정선 1 최호순 3 하현령 2 Voice Comparison between Strap Muscle Retraction and Cutting Technique in Thyroidectomy Young-Mo Kim, MD 1, Jung-Il Cho, MD 1, Chul-Ho Kim, MD 1, Jung-Sun Park, MD 1, Ho-Soon Choi, MD 3 and Hyun-Roung Ha, MD 2 1 Department of Otorhinolaryngology-Head & Neck Surgery and 2 Voice Dynamic Laboratory, College of Medicine, Inha University, Inchon; and 3 Department of Otorhinolaryngology-Head & Neck Surgery, Inchon Christian Hospital, Inchon, Korea ABSTRACT Background and ObjectivesA voice analysis was carried out before and after thyroid surgeries without laryngeal nerve injury, between strap muscle retraction and cutting group in thyroid surgery. The study was done by means of questionaires, acoustics and aerodynamic analysis. Materials and MethodsA total of fourty-two patients of whom thirty-eight are females and four are males were analyzedhemithyroidectomy 19 cases and total thyroidectomy 23 cases. Twenty-seven patients had undergone thyroidectomy via retraction of strap muscle and 15 patients had undergone thyroidectomy via cutting of strap muscle. For evaluation of voice, questionaires for changes of voice, acoustics fundamental frequency, jitter, shimmer, noise to harmonic ratio, voice intensity, vocal range, and aerodynamic maximal phonation time, mean flow rate and subglottal pressure analyses were done. ResultsThe subjective voice symptoms after thyroidectomy were disturbances of high pitch, loud voice and singing voice, and easy fatigue at phonation. These voice symptoms were related to the extent of surgery. Vocal range was the only diminished parameter in acoustic and aerodynamic analyses after thyroidectomy. There were significant differences in jitter on acoustic and aerodynamic analyses between the strap muscle retraction group and the cutting group. ConclusionVoice alteration after thyroidectomy without laryngeal nerve injury may be associated with the disturbance of the extralaryngeal skeleton-laryngotracheal fixation with impairment of vertical movement or by temporal malfunction of the strap muscles. These voice problems were related to the extent of surgery and cutting of strap muscles. (Korean J Otolaryngol 2000;43:985-91) KEY WORDSThyroidectomy Strap muscle Voice analysis. 985

2 수술방법 음성검사 ( 설문지, 음향학적, 공기역학적검사 ) 986 후두스트로보스코피와근전도 통계분석 Korean J Otolaryngol 2000;43:985-91

3 주관적인증상 Fig. 1. The changes of voice symptoms after thyroidectomy. This figure shows that these symptoms gradually improved with time. EFeasy fatigue, SVdisturbance of the singing voice, HPdisturbance of the high pitch, Hhoarseness, LV disturbance of the loud voice. 전체환자군에서의술전술후음성분석 Fig. 2. Comparison of voice symptoms between strap muscle retraction and cutting technique in thyroidectomy. EFeasy fatigue, SVdisturbance of the singing voice, HPdisturbance of the high pitch, Hhoarseness, LVdisturbance of the loud voice. Fig. 3. Comparison of voice symptoms between total thyroidectomy and hemithyroidectomy. EFeasy fatigue, SVdisturbance of the singing voice, HPdisturbance of the high pitch, Hhoarseness, LVdisturbance of the loud voice. 987

4 Table 1. Acoustic and aerodynamic results before and after thyroidectomy in surgical thyroid disorders n42 Preoperative Postoperative Fo Jitter Shimmer NHR MPT MFR SubP VI Vlow Vhigh* Vrange* Fofundamental frequency Hz, Jitter %, Shimmer db, NHRnoise to harmonic ratio db, MPTmaximum phonation time sec, MFRmean flow ratel/sec, SubPsubglottal pressure cmh2o, VIvoice intensity db, Vlowlowest musical scales Hz, Vhighhighest musical scales Hz, Vrangevocal range musical scale *p0.05, analysis of variance by paired t-test Table 2. Acoustic and aerodynamic results before and after thyroidectomy in strap muscle retraction group n27 Preoperative Postoperative Fo Jitter Shimmer NHR* MPT MFR SubP VI Vlow Vhigh* Vrange* Fofundamental frequency Hz, Jitter %, Shimmer db, NHRnoise to harmonic ratio db, MPTmaximum phonation time sec, MFRmean flow ratel/sec, SubPsubglottal pressure cmh2o, VIvoice intensity db, Vlowlowest musical scales Hz, Vhighhighest musical scales Hz, Vrangevocal range musical scale *p0.05, analysis of variance by paired t-test Table 3. Acoustic and aerodynamic results before and after thyroidectomy in strap muscle cutting group n15 Preoperative Postoperative Fo Jitter* Shimmer NHR MPT MFR SubP VI Vlow Vhigh* Vrange* Fofundamental frequency Hz, Jitter %, Shimmer db, NHRnoise to harmonic ratio db, MPTmaximum phonation time sec, MFRmean flow rate L/sec, SubPsubglottal pressure cmh2o, VIvoice intensity db, Vlow lowest musical scales Hz, Vhighhighest musical scales Hz, Vrangevocal range musical scale *p0.05, analysis of variance by paired t-test Table 4. Voice comparison between strap muscle retraction and cutting technique in thyroidectomy (n42) Retraction Cutting Fo` Jitter`* Shimmer` NHR` MPT` MFR` SubP` VI` Vlow` Vhigh` Vrange` Fo`preoperative Fo-postoperative Fo difference value, Fofundamental frequency Hz, Jitter %, Shimmer db, NHRnoise to harmonic ratio db, MPTmaximum phonation time sec, MFRmean flow rate L/sec, SubPsubglottal pressure cmh2o, VIvoice intensity db, Vlowlowest musical scales Hz, Vhighhighest musical scales Hz, Vrangevocal range musical scale 피대근견인군에서의술전술후음성분석 피대근절개군에서의술전술후음성분석 988 Korean J Otolaryngol 2000;43:985-91

5 Table 5. Voice comparison between hemithyroidectomy n 19and total thyroidectomy n23 Hemithyroidectomy 피대근견인군과절개군간의비교 수술범위에따른음성분석 Total thyroidectomy Fo` Jitter` Shimmer` NHR` MPT` MFR` SubP` VI` Vlow` Vhigh` Vrange` Fo`preoperaive Fo - postoperative Fo diffenence value, Fo fundamental frequency Hz, Jitter %, Shimmer db, NHR noise to harmonic ratio db, MPT maximum phonation time sec, MFRmean flow rate L/sec, SubP subglottal pressure cmh2o, VIvoice intensity db, Vlow lowest musical scales Hz, Vhigh highest musical scales Hz, Vrangevocal range musical scale 989

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