Voice restoration after neck surgery

 

The negative consequences that occur in patients after surgery on the neck or chest range from minor changes in voice to serious respiratory disorders. Despite the use of neuromonitoring technology, which helps the surgeon avoid damage to the nervous tissue during surgery, such phenomena appear due to edema or hematomas in the first days after surgery, as well as scarring of the tissues surrounding the nerves in the next 2-3 months. Nerve damage is primarily manifested in impaired movement in one or both halves of the larynx. Such a motor disorder, lasting less than a year, is regarded as laryngeal paresis. According to experts, after this time, if there is no restoration of the functions of the vocal apparatus, the changes are considered irreversible and turn into laryngeal paralysis. According to statistics, from 70 to 90% of paresis and, as a result, laryngeal paralysis occurs after thyroid surgery, the remaining 10-30% occur as a result of other operations on the neck and chest. 

Symptoms of unilateral paresis include voice fatigue, a decrease in conversational intonation, up to monotony, and the strength of the spoken voice. With bilateral damage to the nerves of the larynx, the main symptom is suffocation, which can endanger the patient's life. To identify the nerve lesion, the EMC Clinic's phoniatrician performs a comprehensive diagnosis, including indirect laryngoscopy, videolaryngoscopy, and videostroboscopy. Laryngoscopy allows you to examine the condition of the vocal cords at high magnification, and video stroboscopy allows you to evaluate the correctness of their work. The stroboscope records the work of the vocal folds in slow motion and makes it possible to track even micro-movements that are not noticeable to the naked eye. This helps the doctor distinguish the neurological nature of the real estate of the vocal fold from the mechanical one, which can also cause a deterioration in vocal function. 

Experts note that with minor damage to the motor nerves, spontaneous restoration of laryngeal mobility or significant improvement in vocal function is possible without complete restoration of movement in the larynx within 6-12 months after surgery. However, practice shows that patients who are under the supervision of a phoniatrician during this period achieve much greater recovery results. Conservative treatment traditionally combines drug therapy and physiotherapy aimed at improving neuromuscular conduction and stimulating the laryngeal muscles. 

The best results can be achieved by using special breathing and speech exercises: the EMC phoniatrician conducts personal phonopedic correction classes, selecting an individual complex and monitoring the effectiveness of therapy after each appointment. All patients of the European Medical Center undergoing surgical treatment on the neck or thyroid gland are examined by the attending physician for paresis and, if necessary, referred to a phoniatrician for monitoring and restoration of vocal functions.