Non-neural Vocal Changes After Thyroidectomy
Non-neural Vocal Changes After Thyroidectomy
The purpose of this study is to test the investigators hypothesis that intubation with a
 smaller ETT would lead to reduced postoperative vocal impairment and laryngoscopic evidence
 of laryngeal trauma than intubation with a standard size ETT.
The optimum size of endotracheal tube (ETT) for general anaesthesia remains a matter of
 debate. Choice of ETT size may be of particular pertinence during thyroid surgery, for a
 number or reasons. Because of the strong attachments of the thyroid gland to the trachea,
 intraoperative mobilization of the thyroid will lead to inevitable movement of the trachea
 and larynx against the fixed ETT, with consequent risk of traumatic injury to tracheal
 mucosa, vocal cords, and arytenoids. Thus thyroidectomy is likely to be associated with a
 greater risk of laryngeal trauma related to the ETT than operations outside the Head and Neck
 region where there is no movement of the larynx. On top of this, postoperative vocal
 impairment comprises one of the most important concerns after thyroidectomy, usually
 attributed to impaired vocal fold function secondary to recurrent laryngeal nerve injury.
 However, post-thyroidectomy vocal impairment can also occur in cases where the recurrent
 laryngeal nerve is preserved. Thus, concerns regarding vocal outcomes after thyroidectomy
 tend to be foremost in the mind of both the surgeon and the patient, and any measures which
 can be taken to minimize post-thyroidectomy hoarseness, which might include choosing the
 optimal ETT size, would appear to constitute a worthwhile endeavor.

 Laryngeal trauma due to endotracheal intubation is probably more common than appreciated,
 however, given that symptoms of sore throat and hoarseness after most operations are
 generally self-limiting, this is not usually a major cause of concern. On the other hand,
 postoperative vocal symptoms may be a major cause of anxiety after thyroidectomy, due to fear
 of damage to the recurrent laryngeal nerve or the external branch of the superior laryngeal
 nerve (SLN). Laryngeal trauma without impairment of vocal fold function has been reported to
 be a significant cause of vocal symptoms after thyroid surgery. However, no previously
 published study has attempted to correlate post-thyroidectomy vocal symptoms or signs of
 laryngeal trauma with ETT size.

 The hypothesis of the present study was that intubation with a smaller size ETT would lead to
 less trauma to the larynx during thyroidectomy than intubation with a standard size tube, and
 this would be reflected through less postoperative throat symptoms and objective laryngeal
 alterations. The rationale for this hypothesis was that a smaller caliber tube would be less
 unyielding when the larynx is moved against it, and thus would lead to less laryngeal injury.
 In order to address this question, the investigators designed a randomized controlled trial,
 comparing the impact of intubation with a smaller size tube (size 6.5 for females, and size 7
 for males) with that of intubation with ETTs of the standard size used in the investigators
 department (size 7.5 for females, and size 8 for males).
Inclusion Criteria:

 -  patients aged 18 years and over scheduled to undergo thyroid surgery performed by one
 of two surgeons for benign or malignant thyroid disease during the study

 Exclusion Criteria:

 -  pre-existing vocal cord palsy or major vocal cord pathology; patients with invasive
 thyroid cancers; and patients undergoing concomitant lateral neck dissection