Premium
Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: The I nternational N eural M onitoring S tudy G roup's POLT study
Author(s) -
Schneider Rick,
Randolph Gregory,
Dionigi Gianlorenzo,
Barczyński Marcin,
Chiang FengYu,
Triponez Frédéric,
Vamvakidis Kyriakos,
Brauckhoff Katrin,
Musholt Thomas J.,
Almquist Martin,
Innaro Nadia,
JimenezGarcia Antonio,
Kraimps JeanLouis,
Miyauchi Akira,
Wojtczak Beata,
Donatini Gianluca,
Lombardi Davide,
Müller Uwe,
Pezzullo Luciano,
Ratia Tomas,
Van Slycke Sam,
Nguyen Thanh Phuong,
Lorenz Kerstin,
Sekulla Carsten,
Machens Andreas,
Dralle Henning
Publication year - 2016
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.25807
Subject(s) - medicine , recurrent laryngeal nerve , prospective cohort study , nerve injury , palsy , laryngoscopy , surgery , anesthesia , thyroidectomy , vocal cord paralysis , paralysis , thyroid , intubation , pathology , alternative medicine
Objectives/Hypothesis Intraoperative neuromonitoring identifies recurrent laryngeal nerve (RLN) injury and gives prognostic information regarding postoperative glottic function. Loss of the neuromonitoring signal (LOS) signifies segmental type 1 or global type 2 RLN injury. This study aimed at identifying risk factors for RLN injury and determining vocal fold (VF) function initially and 6 months after definitive LOS. Study Design Prospective study encompassing 21 hospitals from 13 countries. Methods Included in this study were patients with persistent intraoperative LOS. Results At first postoperative laryngoscopy, early VF palsy was present in 94 of all 115 patients with LOS (81.7%): in 53 of 56 patients (94.6%) with type 1 injury and 41 of 59 patients (69.5%) with type 2 injury. In LOS type 1, women outnumbered men >5‐fold. Traction produced LOS type 1 in 38 of 56 patients (67.9%) and LOS type 2 in 54 of 59 patients (91.5%). Course of the RLN posterior and/or anterior to the inferior thyroid artery, extralaryngeal branching, or tuberculum of Zuckerkandl did not increase VF palsy rates. Permanent VF palsy rates were also lower ( P = .661) after LOS type 2 than after LOS type 1: 6.8% (four of 59 patients) versus 10.7% (six of 56 patients). Intraoperative administration of steroids did not diminish postoperative VF palsy rates. Conclusions LOS type 1 entails more severe nerve damage than LOS type 2, affecting women disproportionately. Both LOS types, being primarily associated with traction injury, are unaffected by variant neck anatomy in expert hands and unresponsive to steroids. Level of Evidence 2b Laryngoscope , 126:1260–1266, 2016