Assessment of Voice Outcomes after Thyroidectomy Using Voice Handicap Index Questionnaire

Abstract

Background: Voice disturbance is a recognized complication following thyroidectomy and may occur despite preservation of vocal cord mobility. The Voice Handicap Index (VHI) is a validated patient-reported outcome measure that comprehensively evaluates the functional impact of postoperative voice changes and facilitates early identification of voice impairment.

Objective: To determine voice outcomes following total thyroidectomy for benign thyroid disease using the Voice Handicap Index questionnaire and to identify factors associated with postoperative voice impairment and vocal cord palsy.

Methods: This descriptive study was conducted in the Department of General Surgery, Jinnah Postgraduate Medical Centre, Karachi, over six months after institutional ethical approval. A total of 174 adult patients undergoing total thyroidectomy for benign thyroid disease were enrolled through non-probability consecutive sampling. Preoperative and postoperative voice outcomes were assessed using the validated Voice Handicap Index questionnaire and indirect laryngoscopy. Significant voice impairment was defined as an increase of ≥18 points in VHI score. Data were analyzed using SPSS version 26. Continuous variables were summarized as mean ± standard deviation or median (interquartile range), while categorical variables were expressed as frequencies and percentages. Associations were evaluated using the Chi-square test or Fisher's exact test, with p<0.05 considered statistically significant.

Results: The mean age was 39.8 ± 10.7 years, and 103 (59.2%) participants were female. The median VHI score increased from 11 (IQR: 7–16) preoperatively to 18 (IQR: 11–28) postoperatively. Significant postoperative voice impairment was observed in 39 (22.4%) patients, whereas postoperative vocal cord palsy occurred in 9 (5.2%). Diabetes mellitus was significantly associated with postoperative voice impairment (34.9% vs. 18.3%; p=0.024). No significant associations were observed between postoperative voice impairment and age, gender, body mass index, or residential status. Postoperative vocal cord palsy showed no significant association with any evaluated demographic or clinical variable.

Conclusion: Postoperative voice impairment is relatively common following total thyroidectomy despite a low incidence of postoperative vocal cord palsy. Routine assessment using the Voice Handicap Index together with laryngoscopic examination may facilitate early detection of voice dysfunction, improve postoperative counselling, and support timely rehabilitation. Diabetes mellitus may be associated with an increased risk of postoperative voice impairment and warrants further investigation