Hoarseness is a dreaded complication after thyroidectomy. Even in the most experienced hands, significant postoperative voice changes occur in more than 5% to 10% of patients. Echternach et al report that 42% of patients undergoing thyroidectomy at their institution experienced a laryngeal complication. Most of these complications were unrelated to injury to the recurrent nerve by the surgeon but caused by trauma to the vocal folds after intubation. While these finding are enlightening (and relieving!) to those of us who perform thyroid operations, there are still unresolved issues and questions about the data in this study. First, there are no data about patient symptoms associated with the laryngeal complications. If most patients did not have symptoms, what is the clinical importance of the findings? Second, do we know for certain that most of the vocal fold injuries were caused by endotracheal intubation rather than intraoperative abrasions or trauma from pulling on the thyroid and trachea during removal of the gland? Is the incidence of vocal fold trauma in patients undergoing operations on the outside of the neck similar? A control group such as this would have provided this information. Third, there are no data in this article to suggest that recognizing laryngeal dysfunction preoperatively or postoperatively affects patient outcomes. Fourth, because only 23.8% of patients with laryngeal injuries received long-term follow-up, we do not know the long-term implications of these injuries. It is hoped that additional data from this group and others will shed light on these important issues.
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