Older Age Associated with Voice, Swallowing Changes After Thyroidectomy

What is the impact of age and frailty on the incidence of voice and swallowing alterations after thyroidectomy?

Bottom Line
Age ≥50 years is independently associated with the development of voice or swallowing changes after thyroidectomy, despite intact recurrent laryngeal nerve (RLN).

Background: Despite intact RLNs, voice and swallowing alterations after total thyroidectomy are increasingly prevalent, with studies reporting rates up to 87%. Risk factors identified in prior studies include the presence of gastroesophageal reflux disease (GERD), frequent voice use, smoking history, prior neck surgery, and arytenoid trauma due to endotracheal intubation. Aging alone can cause changes in the structure, motility, and coordination of swallowing, but the roles of age and frailty as potential risk factors for postoperative voice and swallowing changes after total thyroidectomy have not been well studied.

Study design: Retrospective review of 924 consecutive patients who underwent total thyroidectomy with intraoperative RLN monitoring at a single institution between January 2014 and September 2016.

Setting: Johns Hopkins University School of Medicine, Baltimore.

Synopsis: The majority of patients were female and white, mean patient age was 51.1 years, 428 patients were <50 years old, and 496 patients were ≥50 years old. Of the 924 patients, 174 reported voice or swallowing change postoperatively, 148 reported an alteration with their voice, and 51 reported a change with their swallowing. Among patients <50 years, 56 reported voice changes, 17 reported swallowing changes, and 67 reported swallowing or voice changes. Among patients ≥50 years, 92 reported voice changes, 34 reported swallowing changes, and 107 reported swallowing or voice changes. Voice changes increased until about age 50 years, plateaued until about age 65, and then slightly declined; however, they were still higher than in patients younger than age 50. Voice or swallowing changes increased steadily until around age 50 years and then plateaued thereafter, remaining higher than rates in those younger than age 50. Postoperative voice changes were significantly associated with frequent voice use in both age groups. Postoperative swallowing changes were significantly associated with presence of GERD in patients <50 years and with a malignant final pathology among patients ≥50 years. Reported changes in each age group were not significantly associated with BMI, race, gender, history of previous neck surgery, surgery type, Modified Frailty Index (mFI), or smoking history. On both univariate and multivariate analysis, mFI was not found to have a significant association with either voice or swallowing changes. Limitations included the study’s retrospective nature, the likely underestimation of the observed incidence of voice and swallowing changes, limited follow-up, and a lack of objective standardized assessment in all patients.

Citation: Sahli Z, Canner JK, Najjar O, et al. Association between age and patient-reported changes in voice and swallowing after thyroidectomy. Laryngoscope. 2019;129:519–524.