Neuromuscular electrophonopedic stimulation of the larynx after surgical treatment of patients with differentiated thyroid cancer

Abstract

BACKGROUND: Thyroid cancer is the most common endocrine malignancy, accounting for 3.4% of all cancers diagnosed annually. Differentiated thyroid cancer (DTC) is primarily treated with surgery, which can often involve complications such as postoperative pareses or reversible laryngeal nerve (RLN) paralysis. Currently, rehabilitation possibilities for patients with postoperative RLN pairs are relevant. In this study, we used neuromuscular electrostimulation with vocaSTIM in combination with drug therapy and evaluated the effectiveness of the rehabilitation.

AIMS: To determine the possibility of using neuromuscular electrophonopathic laryngeal stimulation (NMELS) in restoring laryngeal function after surgical treatment of DTC complicated by pareses/paralysis of thr RLN.

MATERIALS AND METHODS: Seventy-six patients with DTC who have undergone surgical treatment, complicated by paresis of RLN, were enrolled in this study.

RESULTS: The study analyzed the treatment results of these 76 patients. The age of the patients ranged from 6 to 78 (average age, 47) years, the female-to-male ratio was 59 to 17 (women, 77.6%; men, 22.4%). Postoperative unilateral laryngeal paresis was present in 56 patients (73.68%) and bilateral lesions in 20 (26.32%). Phonation violation was found in all patients: dysphonia, 76 (100%); dysphagia, 28 (36.84%); and respiratory failure, 11 (14.47%), and 2 patients (2.63%) were tracheotomized postoperatively. All patients underwent neuro-phonic rehabilitation with mandatory assessment and video fixation of laryngeal function. As a result of neuromuscular electrophonopathic stimulation of the larynx, 69 out of 76 patients (90.79%) had improved larynx function.

CONCLUSIONS: Based on our experience, NMELS with vocaSTIM can be used for restoring the functions of the larynx in patients with RLN paresis of varying severities, after surgical treatment for DTC.

Keywords

neuromuscular electrophonopedic stimulation / recurrent laryngeal nerve paresis / thyroid surgery / differentiated thyroid cancer

References

[1] Prete A, Borges de Souza P, Censi S, et al. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol. 2020:11:102. doi: 10.3389/fendo.2020.00102

[2] Prete A., Borges de Souza P., Censi S., et al. Update on fundamental mechanisms of thyroid cancer // Front Endocrinol (Lausanne). 2020. Vol. 11. P. 102. doi: 10.3389/fendo.2020.00102

[3] Stewart LA, Kuo JH. Advancements in the treatment of differentiated thyroid cancer. Ther Adv Endocrinol Metab. 2021;12: 20420188211000251. doi: 10.1177/20420188211000251

[4] Stewart L.A., Kuo J.H. Advancements in the treatment of differentiated thyroid cancer // Ther Adv Endocrinol Metab. 2021. Vol. 12. P. 20420188211000251. doi: 10.1177/20420188211000251

[5] Luster M, Clarke SE, Dietlein M, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35(10):1941–1959. doi:10.1007/s00259-008-0883-1

[6] Luster M., Clarke S.E., Dietlein M., et al. Guidelines for radioiodine therapy of differentiated thyroid cancer // Eur J Nucl Med Mol Imaging. 2008. Vol. 35, N 10. P. 1941–1959. doi: 10.1007/s00259-008-0883-1

[7] Medas F, Canu GL, Boi F, et al. Predictive factors of recurrence in patients with differentiated thyroid carcinoma: a retrospective analysis on 579 patients. Cancers (Basel). 2019;11(9):1230. doi: 10.3390/cancers11091230

[8] Medas F., Canu G.L., Boi F., et al. Predictive factors of recurrence in patients with differentiated thyroid carcinoma: a retrospective analysis on 579 patients // Cancers (Basel). 2019. Vol. 11, N 9. P. 1230. doi: 10.3390/cancers11091230

[9] Panh J. Basis und konzeption der therapie von larynxparesen durch neuromuskulare elektrophonatorische stimulation (NMEPS). Kurze einfmhrung in die therapie von larynxparesen, aphasie, dysphasie und dysartrie mit dem Gerltekonzept vocaSTIM. 2002. 24 p.

[10] Panh J. Basis und konzeption der therapie von larynxparesen durch neuromuskulare elektrophonatorische stimulation (NMEPS) // Kurze einfmhrung in die therapie von larynxparesen, aphasie, dysphasie und dysartrie mit dem Gerltekonzept vocaSTIM. 2002. 24 p.

[11] Cirocchi R, Arezzo A, D’Andrea V, et al. Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery. Cochrane Database Syst Rev. 2019;1(1):CD012483. doi: 10.1002/14651858.CD012483.pub2

[12] Cirocchi R., Arezzo A., D’Andrea V., et al. Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery // Cochrane Database Syst Rev. 2019. Vol. 1, N 1. P. CD012483. doi: 10.1002/14651858.CD012483.pub2

[13] Addasi N, Fingeret A, Goldner W. Hemithyroidectomy for thyroid cancer: a review. Medicina (Kaunas). 2020;56(11):586. doi: 10.3390/medicina56110586

[14] Addasi N., Fingeret A., Goldner W. Hemithyroidectomy for thyroid cancer: a review // Medicina (Kaunas). 2020. Vol. 56, N 11. P. 586. doi: 10.3390/medicina56110586

[15] Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009;96(3):240–246. doi: 10.1002/bjs.6417

[16] Barczyński M., Konturek A., Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy // Br J Surg. 2009. Vol. 96, N 3. P. 240–246. doi: 10.1002/bjs.6417

[17] Lynch J, Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: a review. Head Neck. 2017;39(7):1470–1478. doi: 10.1002/hed.24772

[18] Lynch J., Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: a review // Head Neck. 2017. Vol. 39, N 7. P. 1470–1478. doi: 10.1002/hed.24772

[19] Krasnodębska P, Domeracka-Kołodziej A, Szkiełkowska A, et al. Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx. Otolaryngol Pol. 2018;72(2):36–34. doi: 10.5604/01.3001.0011.7250

[20] Krasnodębska P., Domeracka-Kołodziej A., Szkiełkowska A., et al. Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx // Otolaryngol Pol. 2018. Vol. 72, N 2. P. 36–34. doi: 10.5604/01.3001.0011.7250

[21] Kosztyła-Hojna B, Moskal D, Rogowski M, et al. The usage of modern physioterapeutic methods of rehabilitation in treatment of chosen kinds of dysphonia. Otolaryngol Pol. 2012;66(5):328–336. doi: 10.1016/j.otpol.2012.06.020

[22] Kosztyła-Hojna B., Moskal D., Rogowski M., et al. The usage of modern physioterapeutic methods of rehabilitation in treatment of chosen kinds of dysphonia // Otolaryngol Pol. 2012. Vol. 66, N 5. P. 328–336. doi: 10.1016/j.otpol.2012.06.020

[23] Shelesko EV, Abdulgamidov AH, Chernikova NA, et al. Electrical stimulation for paresis of the larynx and pharynx. Literature review. Evrazijskij nauchnyj zhurnal. 2021;(7): 3–10. (In Russ).

[24] Шелеско Е.В., Абдулгамидов А.Х., Черникова Н.А., и др. Электрическая стимуляция при парезах гортани и глотки. Обзор литературы // Евразийский научный журнал. 2021. № 7. С. 3–10.

[25] Hyman A. Resuscitation of the stopped heart in intracardial therapy. II. Experimental use of an artificial pacemaker. American Heart Journal. 1933;8(4):563–564. doi: 10.1016/s0002-87 03(33)9067

[26] Hyman A. Resuscitation of the stopped heart in intracardial therapy. II. Experimental use of an artificial pacemaker // American Heart Journal. 1933. Vol. 8, N 4. P. 563–564. doi: 10.1016/s0002-87 03(33)9067

[27] Zealear DL, Rainey CL, Herzon GD, et al. Electrical pacing of the paralyzed human larynx. Ann Otol Rhinol Laryngol. 1996;105(9): 689–693. doi: 10.1177/000348949610500904

[28] Zealear D.L., Rainey C.L., Herzon G.D., et al. Electrical pacing of the paralyzed human larynx // Ann Otol Rhinol LaryngolAnnals of Otology, Rhinology & Laryngology. 1996. Vol. 105, N. 9. P. 689–693. doi: 10.1177/000348949610500904

[29] Bedareva NA, Evnevich GV. The use of neuromuscular stimulation of laryngeal muscles with the vocaSTIM apparatus for the treatment of bulbar disorders. Russian journal of physiotherapy, balneology and rehabilitation. 2013;5:45–46. (In Russ).

[30] Бедарева Н.А., Евневич Г.В. Опыт использования нейромышечной стимуляции мышц гортани аппаратом Вокастим при лечении бульбарных расстройств. // Физиотерапия, бальнеология и реабилитация. 2013. № 5. C. 45–46.

[31] Shilenkova VV, Filatova EA, Korotchenko VV. Reabilitacija golosa u bol’nyh gipotonusnoj disfoniej metodom nejromyshechnoj jelektrofonopedicheskoj stimuljacii gortani. Rossijskaja otorinolaringologija. 2007;(2):121–125. (In Russ).

[32] Шиленкова В.В., Филатова Е.А., Коротченко В.В. Реабилитация голоса у больных гипотонусной дисфонией методом нейромышечной электрофонопедической стимуляции гортани // Российская оториноларингология. 2007. № 2. С. 121–125.

[33] Stepanova JE, Gotovyahina TV, Mokhotaeva MV, Mahotkina NN. Complex rehabilitation of patients with unilateral vocal fold paresis after thyroid surgery (medical and pedagogical recommendations). Russian otorhinolaryngology. 2014;4:131–137. (In Russ).

[34] Степанова Ю.Е., Готовяхина Т.В., Мохотаева М.В., Махоткина Н.Н. Комплексная реабилитация пациентов с односторонним парезом гортани после хирургического вмешательства на щитовидной железе (медико-педагогические рекомендации) // Российская оториноларингология. 2014. № 4. С. 131–137.

[35] Kryukov AI, Romanenko SG, Pavlikhin OG, Lesogorova EV. Clinical and functional state of the larynx in older patients with chronic edematous-polypous laryngitis. Bulletin of otorhinolaryngology. 2018;83(1):56–58. (In Russ). doi: 10.17116/otorino201883156-58

[36] Крюков А.И., Романенко С.Г., Павлихин О.Г., Лесогорова Е.В. Клинико-функциональное состояние гортани у пациентов старшей возрастной группы с хроническим отечно-полипозным ларингитом // Вестник оториноларингологии. 2018. Т. 83, № 1. С. 56–58. doi: 10.17116/otorino201883156-58

RIGHTS & PERMISSIONS

Eco-Vector