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March 27, 2015

Professional Singers' Vocal Issues after Thyroid Surgery

A study out of Harvard presented the typical vocal outcomes after thyroid surgery in professional singers. No other study has ever looked at this special patient population who are the Olympic athletes of the voice. Non-singers may be completely unaware of any subtle issues with the voice after thyroid surgery. However, for professional singers, even the slightest vocal quiver could be professionally unacceptable.

The main issue with thyroid surgery as it pertains to the voice is that the nerve that controls vocal cord movement goes right thru the thyroid gland. With thyroid surgery, the risk is injury to this nerve which would than affect the voice. Worst case, the nerve could get accidentally cut resulting in permanent vocal cord paralysis.

This study looked at 27 professional singers who underwent thyroid surgery, 60% due to cancer. What they found was return to performance rate was 100%, mean time to performance after surgery was 2.26 months (± 1.61). All three vocal instrument mean scores, pre-op vs. post-op, were unchanged:

• Voice Handicap Index (VHI): 4.15 (± 5.22) vs 4.04 (± 3.85), p = 0.9301
• Singing Voice Handicap Index (SVHI): 11.26 (± 14.41) vs 12.07 (± 13.09), p = 0.8297
• Evaluation of Ability to Sing Easily (EASE): 6.19 (± 9.19) vs 6.00 (± 7.72), p = 0.9348

The vocal parameters most affected from surgery until first performances were vocal fatigue (89%), high range (89%), pitch control and modulation (74%) and strength (81%). Final mean intraoperative EMG amplitude was within normal limits for intraoperative stimulation and had no relationship with time to first professional performance (p = 0.7199).

Overall, the study concluded that
"neural monitored thyroidectomy, including for thyroid malignancy, in professional voice users is safe without any changes in three different voice/ singing instruments, with 100% return to performance." [link]
This information is extremely helpful when counseling professional singers and its possible impact on their voice afterwards.

Reference:
Thyroidectomy in the Professional Singer-Neural Monitored Surgical Outcomes. Thyroid. 2015 Mar 19. [Epub ahead of print]


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

1 comment:

  1. I am a soprano soloist, worship leader, vocal coach and director. I have completely lost my singing voice following a thoidectomy. I am 55 years old and my singing has been a calling to me. I believe I was born to do it, because I had a drive to as a child. I have led worship off and on for 30 years. I had a nodular thyroid that was beginning to fluctuate my hormone levels, so it was recommended that I have it removed. After waiting and praying, since I immediately suffered a drastic voice change, I asked my surgeon about it. He told me my nerves were fine, but it would take a couple of months. It's been a year, doing whatever the surgeon told me to do, believing him that my nerves were fine. He referred me by phone to his colleague, a laryngologist, who upon evaluation, said immediately that both nerves on one side have been damaged, and he offered no hope that I will ever recover my singing voice. If anyone out there can help me pursue a case, I want the best help to recover my voice. That's it. danalou2@gmail.com God bless.

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