Pre-op exam, nerve monitor provides valuable thyroid outcomes information

November 18, 2013

BOSTON (Nov. 18, 2013) - Intraoperative recurrent laryngeal nerve (RLN) monitoring has gained popularity with approximately 53 percent of general surgeons and 65 percent of otolaryngologists using intraoperative nerve monitoring in select or all cases. The importance of laryngeal exam prior to thyroid surgery has also been increasingly recognized, but the relationship between surgical outcomes and these two parameters has not been studied.

Researchers at Massachusetts Eye and Ear/Harvard Medical School set out to elucidate the electrophysiologic responses LRNs that were preoperatively paralyzed or invaded by malignancy and to use this information for intraoperative management of cancerous RLNs. Their research is described in the November 2013 issue of the journal Otolaryngology - Head and Neck Surgery.

The study involved retrospective review of all consecutive neck surgeries with nerve monitor performed by senior author Gregory W. Randolph, M.D., director of the division of Thyroid and Parathyroid Surgery at Massachusetts Eye and Ear/Harvard Medical School between December 1995 and January 2007.

Of the 1,138 surgeries performed, 25 patients had preoperative vocal cord dysfunction. In patients with preoperative vocal cord dysfunction, recognizable LRN electrophysiologic activity was preserved in more than 50 percent of the cases. Malignant invasion of the RLN was found in 22 patients. Neural invasion of the RLN was associated with preoperative vocal cord paralysis in only 50 percent of these patients. In nerves invaded by malignancy, 60 percent maintained recognizable electrophysiologic activity, which was more commonly present and robust when vocal cord function was preserved, the authors wrote.

"Knowledge of electrophysiologic intraoperative neural monitoring provides additional functional information and, along with information about the preoperative condition of the vocal cord function, helps to construct decision algorithms regarding intraoperative management of the LRN, predicting postoperative outcomes, and counseling patients on expectations after surgery," said Dr. Randolph, who is also a professor of Otology and Laryngology at Harvard Medical School.
About Massachusetts Eye and Ear

Mass. Eye and Ear clinicians and scientists are driven by a mission to find cures for blindness, deafness and diseases of the head and neck. After uniting with Schepens Eye Research Institute, Mass. Eye and Ear in Boston became the world's largest vision and hearing research center, offering hope and healing to patients everywhere through discovery and innovation. Mass. Eye and Ear is a Harvard Medical School teaching hospital and trains future medical leaders in ophthalmology and otolaryngology, through residency as well as clinical and research fellowships. Internationally acclaimed since its founding in 1824, Mass. Eye and Ear employs full-time, board-certified physicians who offer high-quality and affordable specialty care that ranges from the routine to the very complex. U.S. News & World Report's "Best Hospitals Survey" has consistently ranked the Mass. Eye and Ear Departments of Otolaryngology and Ophthalmology among the top hospitals in the nation.

Massachusetts Eye and Ear Infirmary

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