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研究生:黃子晏
研究生(外文):Huang, Tzu-Yen
論文名稱:神經監測甲狀腺手術之術後音聲障礙研究
論文名稱(外文):Study of Postoperative Voice Impairment in patients receiving Neuromonitored Thyroid Surgery
指導教授:林聖軒
指導教授(外文):Lin, Sheng-Hsuan
口試委員:吳哲維江豐裕王凌峰劉天仁林宗宏黃兆祺林聖軒
口試委員(外文):Wu, Che-WeiChiang, Feng-YuWang, Ling-FengLiu, Tian-RenLin, Zong-HongHwang, EricLin, Sheng-Hsuan
口試日期:2022-01-20
學位類別:博士
校院名稱:國立陽明交通大學
系所名稱:生物科技學系
學門:生命科學學門
學類:生物科技學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:68
中文關鍵詞:甲狀腺手術甲狀腺術後音聲障礙術中神經監測聲帶運動主客觀音聲分析高頻音聲障礙甲狀腺手術音聲吞嚥障礙指數
外文關鍵詞:Thyroid surgeryPost-thyroidectomy dysphoniaIntraoperative neuromonitoring (IONM)Vocal ford motion (VFM)Subjective/objective voice analysisHigh-pitched voice impairment (HPVI)Index of Voice and Swallowing Handicap of Thyroidectomy (IVST)
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  • 被引用被引用:1
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  • 下載下載:5
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隨著檢查工具及健康意識的提昇,越來越多甲狀腺疾病被診斷,需要執行甲狀腺手術的病人也逐年增加。因甲狀腺所在的位置鄰近喉返神經、上喉神經外支及喉外肌等結構,甲狀腺手術後經常伴隨不同程度的術後音聲障礙。近年來,標準化術中神經監測逐漸被甲狀腺外科醫師廣泛採用,運用術中神經監測,醫師可針對神經損傷定性(機械性損傷、熱損傷)及定量(訊號損失比例),並且常規以術前及術後的喉內視鏡檢查、主觀音聲評估、客觀音聲評估,以分析病人之音聲狀況。本系列研究為首次報導以標準化神經監測及音聲數據,以統計分析建立喉返神經受傷機轉與音聲參數變化、術後聲帶運動障礙與音聲參數變化之關聯性,並提供手術醫師盡力避免嚴重機械性損傷及熱損傷之音聲證據及預後指標。在未傷及喉返神經及上喉神經外支之情形下,主客觀高音頻損傷仍是音聲障礙重要議題,主觀及客觀高音頻損傷不完全相等,影響主觀高音頻損傷的因素更為複雜,需要考慮到音聲穩定性,也需考慮病人的特徵選擇介入方式。
With the improvement of examination tools and health awareness, an increasing number of thyroid diseases have been diagnosed, and the number of patients who require thyroid surgery has also increased each year. Because the thyroid gland is close to the recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN) and extralaryngeal muscles, patients often experience various degrees of post thyroidectomy dysphonia. In recent years, standardized intraoperative neuromonitoring (IONM) procedures have gradually become commonly accepted by thyroid surgeons. With IONM, surgeons can qualify (mechanical/thermal injury) and quantify (signal loss ratio), routine pre- and postoperative laryngofiberscopy, and subjective/objective voice analysis to evaluate the patient's voice. This series of studies is the first to report the use of a standardized IONM procedure and subjective/objective voice analysis to establish the correlation between the RLN injury mechanism and postoperative vocal fold motion impairment with voice parameter changes through statistical analysis. The studies also provide voice evidence and prognostic indicators for surgeons to avoid severe mechanical and thermal injuries. Without injury to the RLN and EBSLN, the subjective/objective high-pitched voice impairment (HPVI) is still an important issue. The subjective and objective HPVI are not completely equal, and voice stability should be considered a factor affecting the subjective HPVI. Regarding the patients’ characteristics, the surgeon can choose the appropriate voice intervention for patients.
摘要………………………………………………………………………………………… i
Abstract…………………………………………………………………………………….. ii
誌謝………………………………………………………………………………………... iv
目錄………………………………………………………………………………………... vi
圖目錄………………………………………………………………………………….… viii
表目錄………………………………………………………………………………….….. ix
第一章 背景介紹…………………………………………………………………………. 1
1.1 甲狀腺手術與音聲障礙………………………………………………………… 1
1.2 術中神經監測甲狀腺手術……………………………………………………… 3
1.3 客觀音聲分析…………………………………………………………………… 7
第二章 神經監測甲狀腺手術中喉返神經功能障礙的嚴重程度和機制如何影響術後音聲………………………………………………………………………………………..…. 11
2.1 背景……………………………………………………………………………… 11
2.2 研究方法及材料………………………………………………………………… 13
2.3 結果……………………………………………………………………………… 17
2.4 討論……………………………………………………………………………… 24
2.5 研究限制………………………………………………………………………… 26
第三章 非橫斷性神經損傷與甲狀腺術後聲帶運動障礙的預後指標-術中神經監測與手術間期音聲參數之相關性研究…………………………………………………………... 27
3.1 背景……………………………………………………………………………… 27
3.2 研究方法及材料………………………………………………………………… 28
3.3 結果……………………………………………………………………………… 31
3.4 討論……………………………………………………………………………… 38
3.5 研究限制..……………………………………………………………………….. 41
第四章 甲狀腺手術病人客觀和主觀高音音聲障礙之相關性研究……………………. 42
4.1 背景……………………………………………………………………………… 42
4.2 研究方法及材料………………………………………………………………… 43
4.3 結果……………………………………………………………………………… 46
4.4 討論……………………………………………………………………………… 51
4.5 研究限制..……………………………………………………………………….. 54
第五章 結論..……………………………………………………………………………... 55
參考資料..……………………………………………………………………………......... 57
1. Hu, J., et al., Total thyroidectomy as primary surgical management for thyroid disease: surgical therapy experience from 5559 thyroidectomies in a less-developed region. World Journal of Surgical Oncology, 2015. 14(1): p. 20.
2. Brito, J.P., J.C. Morris, and V.M. Montori, Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ, 2013. 347: p. f4706.
3. Thomas, G., et al., Developing a clinical prototype to guide surgeons for intraoperative label-free identification of parathyroid glands in real time. Thyroid, 2018. 28(11): p. 1517-1531.
4. Moran, K., et al., Energy vessel sealant devices are associated with decreased risk of neck hematoma after thyroid surgery. Updates in surgery, 2020. 72(4): p. 1135-1141.
5. Liang, T.-J., et al., Associations of volume and thyroidectomy outcomes: a nationwide study with systematic review and meta-analysis. Otolaryngology--Head and Neck Surgery, 2016. 155(1): p. 65-75.
6. Zambudio, A.R., et al., Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Annals of surgery, 2004. 240(1): p. 18.
7. Gonçalves Filho, J. and L.P. Kowalski, Postoperative complications of thyroidectomy for differentiated thyroid carcinoma. American journal of otolaryngology, 2004. 25(4): p. 225-230.
8. Djohan, R.S., et al., Intraoperative monitoring of recurrent laryngeal nerve function. The American Surgeon, 2000. 66(6): p. 595.
9. Randolph, G.W., J.B. Kobler, and J. Wilkins, Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation. World journal of surgery, 2004. 28(8): p. 755-760.
10. Beldi, G., T. Kinsbergen, and R. Schlumpf, Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World journal of surgery, 2004. 28(6): p. 589-591.
11. Chiang, F.-Y., et al., The mechanism of recurrent laryngeal nerve injury during thyroid surgery—the application of intraoperative neuromonitoring. Surgery, 2008. 143(6): p. 743-749.
12. Chiang, F.-Y., et al., Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World journal of surgery, 2010. 34(2): p. 223-229.
13. Gardner, G.M., C.M. Shaari, and S.M. Parnes, Long‐term morbidity and mortality in patients undergoing surgery for unilateral vocal cord paralysis. The Laryngoscope, 1992. 102(5): p. 501-508.
14. Neel III, H.B., et al., Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngology—Head and Neck Surgery, 1994. 111(4): p. 497-508.
15. Friedman, M., P. LoSavio, and H. Ibrahim, Superior laryngeal nerve identification and preservation in thyroidectomy. Archives of Otolaryngology - Head and Neck Surgery, 2002. 128(3): p. 296-303.
16. Morton, R.P., P. Whitfield, and S. Al-Ali, Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clinical Otolaryngology, 2006. 31(5): p. 368-74.
17. Chandrasekhar, S.S., et al., Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngology—Head and Neck Surgery, 2013. 148(6_suppl): p. S1-S37.
18. Soylu, L., et al., The evaluation of the causes of subjective voice disturbances after thyroid surgery. The American Journal of Surgery, 2007. 194(3): p. 317-22.
19. Henry, L.R., et al., The functional impact on voice of sternothyroid muscle division during thyroidectomy. Annals of Surgical Oncology, 2008. 15(7): p. 2027-33.
20. Mendels, E.J., et al., Adverse laryngeal effects following short-term general anesthesia: a systematic review. Archives of Otolaryngology - Head and Neck Surgery, 2012. 138(3): p. 257-64.
21. Yu, W.-H.V. and C.-W. Wu, Speech therapy after thyroidectomy. Gland surgery, 2017. 6(5): p. 501.
22. Randolph, G.W., et al., Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. The Laryngoscope, 2011. 121(S1): p. S1-S16.
23. Randolph, G.W., Surgery of the Thyroid and Parathyroid Glands. . Philadelphia, PA: Saunders, 2013.
24. Wu, C.-W., et al., Feasibility of intraoperative neuromonitoring during thyroid surgery using transcartilage surface recording electrodes. Thyroid, 2018. 28(11): p. 1508-1516.
25. Chiang, F.Y., et al., Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy. The Kaohsiung Journal of Medical Sciences, 2017. 33(10): p. 503-509.
26. Liu, C.-H., et al., New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery. Frontiers in Endocrinology, 2021. 12(763170): p. 1-10.
27. Huang, T.-Y., et al., Laryngeal neural monitoring during pediatric thyroid cancer surgery—is transcartilage recording a preferable method? Cancers, 2021. 13(16): p. 4051.
28. Wu, C.W., et al., Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model. Head Neck, 2010. 32(10): p. 1295-301.
29. Melin, M., et al., IONM-guided goiter surgery leading to two-stage thyroidectomy--indication and results. Langenbeck's Archives of Surgery, 2013. 398(3): p. 411-8.
30. Wu, C.W., et al., Loss of signal in recurrent nerve neuromonitoring: causes and management. Gland Surgery, 2015. 4(1): p. 19-26.
31. KayPENTAX, The software instruction manual of the multi-dimensional voice program (MDVP) model 5105. 2008, KayPENTAX Lincoln Park.
32. Iwata, S. and H. von Leden, Voice prints in laryngeal disease. Archives of Otolaryngology, 1970. 91(4): p. 346-351.
33. Meek, P., et al., Voice change following thyroid and parathyroid surgery. Journal of Voice, 2008. 22(6): p. 765-772.
34. Périé, S., et al., Aspiration in unilateral recurrent laryngeal nerve paralysis after surgery. American journal of otolaryngology, 1998. 19(1): p. 18-23.
35. Wu, C.W., et al., Recurrent laryngeal nerve injury with incomplete loss of electromyography signal during monitored thyroidectomy-evaluation and outcome. Langenbeck's Archives of Surgery, 2017. 402(4): p. 691-699.
36. Wu, C.W., et al., Recurrent Laryngeal Nerve (RLN) Injury in Thyroid Surgery: Lessons Learned from the Intraoperative Neural Monitoring (IONM). International Journal of Head and Neck Science 2017. 1(1): p. 19-26.
37. Snyder, S.K., et al., Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. Journal of the American College of Surgeons, 2008. 206(1): p. 123-130.
38. Schneider, R., et al., Prediction of postoperative vocal fold function after intraoperative recovery of loss of signal. The Laryngoscope, 2019. 129(2): p. 525-531.
39. Duclos, A., et al., Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World journal of surgery, 2011. 35(4): p. 773-778.
40. Wu, C.W., et al., Recent Advances in Analysis and Management of Loss of Signal During Monitored Thyroidectomy. International Journal of Head and Neck Science, 2018. 2(4): p. 147-155.
41. Stojadinovic, A., et al., Prospective functional voice assessment in patients undergoing thyroid surgery. Annals of surgery, 2002. 236(6): p. 823.
42. Musholt, T.J., et al., Changes of the speaking and singing voice after thyroid or parathyroid surgery. Surgery, 2006. 140(6): p. 978-989.
43. Sinagra, D.L., et al., Voice changes after thyroidectomy without recurrent laryngeal nerve injury. Journal of the American College of Surgeons, 2004. 199(4): p. 556-560.
44. Rosato, L., et al., Recurrent laryngeal nerve damage and phonetic modifications after total thyroidectomy: surgical malpractice only or predictable sequence? World journal of surgery, 2005. 29(6): p. 780-784.
45. Borel, F., et al., Self-assessment of voice outcomes after total thyroidectomy using the Voice Handicap Index questionnaire: Results of a prospective multicenter study. Surgery, 2020. 167(1): p. 129-136.
46. Lombardi, C.P., et al., Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery, 2006. 140(6): p. 1026-1034.
47. Papadakis, C.E., et al., Subjective and objective voice assessments after recurrent laryngeal nerve-preserved total thyroidectomy. Journal of Voice, 2017. 31(4): p. 515. e15-515. e21.
48. Jeannon, J.P., et al., Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. International journal of clinical practice, 2009. 63(4): p. 624-629.
49. Schneider, R., et al., International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. The Laryngoscope, 2018. 128: p. S1-S17.
50. Wu, C.W., et al., International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer—incorporation of surgical, laryngeal, and neural electrophysiologic data. The Laryngoscope, 2018. 128: p. S18-S27.
51. Chiang, F.-Y., et al., Anatomical variations of recurrent laryngeal nerve during thyroid surgery: how to identify and handle the variations with intraoperative neuromonitoring. The Kaohsiung Journal of Medical Sciences, 2010. 26(11): p. 575-583.
52. Liu, X.-L., et al., Exclusive real-time monitoring during recurrent laryngeal nerve dissection in conventional monitored thyroidectomy. The Kaohsiung Journal of Medical Sciences, 2016. 32(3): p. 135-141.
53. Schneider, R., et al., Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head & Neck, 2013. 35(11): p. 1591-1598.
54. Wu, C.-W., et al., Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: a porcine model. Surgery, 2014. 155(2): p. 329-339.
55. Dionigi, G., et al., Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal. International Journal of Surgery, 2013. 11: p. S44-S46.
56. Dionigi, G., et al., Severity of recurrent laryngeal nerve injuries in thyroid surgery. World journal of surgery, 2016. 40(6): p. 1373-1381.
57. Wang, J.J., et al., Improving Voice Outcomes After Thyroid Surgery–Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve. Frontiers in endocrinology, 2021. 12(795281): p. 1-12
58. Borel, F., et al., Long-term voice quality outcomes after total thyroidectomy: a prospective multicenter study. Surgery, 2018. 163(4): p. 796-800.
59. Dewan, K., et al., Neuromuscular compensation mechanisms in vocal fold paralysis and paresis. The Laryngoscope, 2017. 127(7): p. 1633-1638.
60. Chiang, F.-Y., et al., Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery, 2005. 137(3): p. 342-347.
61. Tsou, Y.-A., et al., Using innovative acoustic analysis to predict the postoperative outcomes of unilateral vocal fold paralysis. BioMed research international, 2016. 2016(7821415): p.1.
62. Christakis, I., et al., Long-term quality of voice is usually acceptable after initial hoarseness caused by a thyroidectomy or a parathyroidectomy. Gland Surgery, 2019. 8(3): p. 226.
63. Reiter, R., et al., Quality of Voice and Prognostic Markers for the Recovery of Vocal Fold Paralysis After Thyroid Surgery. Annals of Otology, Rhinology & Laryngology, 2019. 128(12): p. 1104-1110.
64. Huang, T.-Y., et al., How the Severity and Mechanism of Recurrent Laryngeal Nerve Dysfunction during Monitored Thyroidectomy Impact on Postoperative Voice. Cancers, 2021. 13(21): p. 5379.
65. Rosenthal, L.H.S., M.S. Benninger, and R.H. Deeb, Vocal fold immobility: a longitudinal analysis of etiology over 20 years. The Laryngoscope, 2007. 117(10): p. 1864-1870.
66. Dralle, H., K. Lorenz, and A. Machens, Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions. Head & Neck, 2012. 34(11): p. 1591-1596.
67. Snyder, S.K., et al., Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. Journal of the American College of Surgeons, 2008. 206(1): p. 123-30.
68. Leow, C. and A. Webb, The lateral thyroid ligament of Berry. International surgery, 1998. 83(1): p. 75-78.
69. Yang, S., et al., Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. International Journal of Surgery, 2017. 39: p. 104-113.
70. Randolph, G.W., et al., Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. The Laryngoscope, 2011. 121 Suppl 1: p. S1-16.
71. Crumley, R.L., Unilateral recurrent laryngeal nerve paralysis. Journal of voice, 1994. 8(1): p. 79-83.
72. Huang, T.-Y., et al., Correlation Between Objective and Subjective High-Pitched Voice Impairment in Patients After Thyroid Surgery. Frontiers in Endocrinology, 2021. 12(788878): p. 1-8.
73. Friedman, A.D., et al., Early versus late injection medialization for unilateral vocal cord paralysis. The Laryngoscope, 2010. 120(10): p. 2042-2046.
74. Yung, K.C., I. Likhterov, and M.S. Courey, Effect of temporary vocal fold injection medialization on the rate of permanent medialization laryngoplasty in unilateral vocal fold paralysis patients. The Laryngoscope, 2011. 121(10): p. 2191-2194.
75. Chiang, F.Y., et al., The mechanism of recurrent laryngeal nerve injury during thyroid surgery--the application of intraoperative neuromonitoring. Surgery, 2008. 143(6): p. 743-9.
76. Heuer, R.J., et al., Unilateral recurrent laryngeal nerve paralysis: the importance of “preoperative” voice therapy. Journal of voice, 1997. 11(1): p. 88-94.
77. Schneider, R., et al., Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology. Gland surgery, 2016. 5(6): p. 607.
78. Kim, D.H., S.W. Kim, and S.H. Hwang, Intraoperative neural monitoring for early vocal cord function assessment after thyroid surgery: a systematic review and meta-analysis. World journal of surgery, 2021. 45(11): p. 3320-3327.
79. Liu, C.-H., et al., Comparison of Surgical Complications Rates Between LigaSure Small Jaw and Clamp-and-Tie Hemostatic Technique in 1,000 Neuro-Monitored Thyroidectomies. Frontiers in endocrinology, 2021. 12(638608): p. 1-7.
80. Leclerc, A.-A. and L.J. Smith, Early Management of Unilateral Vocal Fold Paralysis, in Decision Making in Vocal Fold Paralysis. 2019, Springer. p. 29-39.
81. Liddy, W., et al., Varied RLN Course is Associated with Increased Risk of Nerve Dysfunction during Thyroidectomy: Results of the Surgical Anatomy of the RLN in Thyroid Surgery (SAR) Study, an International Multicenter Prospective Anatomic and Electrophysiologic Study of 1000 Monitored Nerves at Risk from the International Neural Monitoring Study Group (INMSG). Thyroid, 2021. 31(11): p. 1730-1740.
82. Sorensen, J.R., et al., The impact of post-thyroidectomy paresis on quality of life in patients with nodular thyroid disease. Otolaryngology–Head and Neck Surgery, 2019. 161(4): p. 589-597.
83. Wang, L.-F., et al., The efficacy of intraoperative corticosteroids in recurrent laryngeal nerve palsy after thyroid surgery. World journal of surgery, 2006. 30(3): p. 299-303.
84. Hydman, J., et al., Diagnosis and prognosis of iatrogenic injury of the recurrent laryngeal nerve. Annals of Otology, Rhinology & Laryngology, 2009. 118(7): p. 506-511.
85. Chung, S.R., et al., Management strategy for nerve damage during radiofrequency ablation of thyroid nodules. International Journal of Hyperthermia, 2019. 36(1): p. 203-209.
86. Lee, S.W., et al., Utility of injection laryngoplasty in the management of post-thyroidectomy vocal cord paralysis. Thyroid, 2010. 20(5): p. 513-517.
87. Lee, S.W. and K.N. Park, A long‐term comparative prospective study between reinnervation and injection laryngoplasty. The Laryngoscope, 2018. 128(8): p. 1893-1897.
88. Zhang, D., et al., Neural monitoring in thyroid surgery is here to stay. Gland surgery, 2020. 9(Suppl 1): p. S43.
89. Siu, J., S. Tam, and K. Fung, A comparison of outcomes in interventions for unilateral vocal fold paralysis: a systematic review. The Laryngoscope, 2016. 126(7): p. 1616-1624.
90. Huang, T.-Y., et al., Prognostic Indicators of Non-Transection Nerve Injury and Vocal Fold Motion Impairment After Thyroid Surgery–Correlation Between Intraoperative Neuromonitoring Findings and Perioperative Voice Parameters. Frontiers in endocrinology, 2021. 12(755231): p. 1-9.
91. Chiang, F.-Y., et al., Detecting and identifying nonrecurrent laryngeal nerve with the application of intraoperative neuromonitoring during thyroid and parathyroid operation. American journal of otolaryngology, 2012. 33(1): p. 1-5.
92. Barczyński, M., et al., External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. The Laryngoscope, 2013. 123: p. S1-S14.
93. Watt, T., et al., Quality of life in patients with benign thyroid disorders. A review. European Journal of Endocrinology, 2006. 154(4): p. 501-510.
94. Kim, S.W., et al., Voice examination in patients with decreased high pitch after thyroidectomy. Indian Journal of Otolaryngology and Head & Neck Surgery, 2012. 64(2): p. 120-130.
95. Barczyński, M., et al., Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World journal of surgery, 2012. 36(6): p. 1340-1347.
96. Soylu, L., et al., The evaluation of the causes of subjective voice disturbances after thyroid surgery. The American journal of surgery, 2007. 194(3): p. 317-322.
97. Park, J.-O., et al., The long-term prognosis of voice pitch change in female patients after thyroid surgery. World journal of surgery, 2016. 40(10): p. 2382-2390.
98. Myers, E.N., K.H. Hong, and Y.K. Kim, Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngology--Head and Neck Surgery, 1997. 117(4): p. 399-404.
99. Titze, I.R. and E.J. Hunter, Normal vibration frequencies of the vocal ligament. The Journal of the Acoustical Society of America, 2004. 115(5): p. 2264-2269.
100. Lowell, S.Y. and B.H. Story, Simulated effects of cricothyroid and thyroarytenoid muscle activation on adult-male vocal fold vibration. The Journal of the Acoustical Society of America, 2006. 120(1): p. 386-397.
101. Park, K.S., et al., Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy: a prospective, randomized controlled study. Journal of the Korean Surgical Society, 2013. 84(6): p. 321-329.
102. Alkan, Z., et al., Effect of anti-adhesive barrier use on laryngotracheal movement after total thyroidectomy: an electrophysiological study. Indian Journal of Otolaryngology and Head & Neck Surgery, 2014. 66(1): p. 71-77.
103. Debruyne, F., et al., Acoustic analysis of the speaking voice after thyroidectomy. Journal of Voice, 1997. 11(4): p. 479-482.
104. Takamura, Y., et al., Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: prospective randomized study. World journal of surgery, 2005. 29(6): p. 775-779.
105. Gove, W.R. and M.R. Geerken, Response bias in surveys of mental health: An empirical investigation. American journal of Sociology, 1977. 82(6): p. 1289-1317.
106. Baron-Epel, O., et al., Extreme and acquiescence bias in a bi-ethnic population. European Journal of Public Health, 2010. 20(5): p. 543-548.
107. Kuru, O. and J. Pasek, Improving social media measurement in surveys: Avoiding acquiescence bias in Facebook research. Computers in Human Behavior, 2016. 57: p. 82-92.
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