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Laryngeal Physiology and Voice Acoustics are Maintained after Minimally Invasive Parathyroidectomy
*Steven B Leder, *Patricia I. Donovan, *Lynn M. Acton, *Heather L. Warner, *Aymen A. Alian, *Tobias Carling, Robert Udelsman
Yale University School of Medicine, New Haven, CT

Objective: Outpatient Minimally Invasive Parathyroidectomy (MIP) utilizes focused exploration under cervical block monitored anesthesia to excise enlarged parathyroid glands employing an intraoperative parathyroid hormone assay to confirm adequacy of resection in patients with primary hyperparathyroidism (1o HPTH). Avoidance of recurrent or superior laryngeal nerve injury, maintenance of normal laryngeal physiology and vocal function are important secondary goals.
Design: Prospective assessment of surgical outcomes and laryngeal function before and after MIP analyzed by intent to treat.
Setting: Tertiary Care Hospital
Patients: 104 patients with 1o HPTH
Interventions: All patients underwent identical, detailed and sensitive pre- and post-operative assessment of laryngeal physiology. True vocal fold mobility was assessed and recorded with transnasal fiberoptic laryngoscopy. Vocal capacity was recorded with maximum phonation time (MPT) and vocal stability by frequency-based voice measures, i.e., mean fundamental frequency (Fo), standard deviation of the fundamental frequency (FoSD), and jitter and shimmer as measured by relative average perturbation (RAP) and amplitude perturbation quotient (APQ), respectively.
Results: 104 patients completed the protocol. MIP was accomplished in 95 patients and 9 were converted to general anesthesia. The intraoperative cure rate of 100% was confirmed by followup biochemical analyses. Laryngeal physiology ratings, including blinded inter- and intra-rater reliability testing performed on 20% of the sample 9-12 months following data acquisition, were 100%. One patient (<1%) exhibited a recurrent laryngeal nerve injury. There were no differences (p>0.05) comparing pre- and post-operative MIP for any objective voice parameter, i.e., MPT, Fo, FoSD, RAP, or APQ.
Conclusions: MIP can be performed with exquisite disease control with minimal effects on laryngeal physiology or objective voice acoustic measures. For the first time, both laryngeal physiology and acoustic data support MIP.

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