{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:05:04Z","timestamp":1787702704491,"version":"build-2784847793"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,1,31]],"date-time":"2021-01-31T00:00:00Z","timestamp":1612051200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives\/Hypothesis<\/jats:title>\n                    <jats:p>The objective was to identify whether injury of the external branch of the superior laryngeal nerve (EBSLN) or changes in EBSLN parameters after dissection during thyroidectomies correlate with changes in voice quality postoperatively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Prospective multicenter case series.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective multicenter study was conducted on patients undergoing thyroidectomies with intraoperative nerve monitoring. Electromyography waveforms of EBSLN stimulation before (S1) and after superior pole dissection (S2) were evaluated using endotracheal tube (ETT) and cricothyroid intramuscular (CTM) electrodes. Voice outcomes were assessed using Voice\u2010Related Quality of Life Surveys and Voice Handicap Index.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 131 at\u2010risk EBSLNs were evaluated in 80 patients. Two nerves showed loss of CTM twitch coupled with an absent S2 signal response. Complete EBSLN loss of signal was more likely with: 1) Cernea EBSLN anatomic classification Type 2B; 2) with a longer distance from the sternothyroid muscle insertion site; and 3) with larger lobar volumes (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.05). Patients who experienced a more than 50% decrement in CTM amplitudes of S2 (n = 7) by CTM electrodes had a statistically significant decline in their voice outcomes compared to those who did not (n = 69) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u2009.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients experienced worse voice outcomes when at least one EBSLN response amplitude decreased by more than 50% after dissection when measured by CTM needle electrodes. CTM needle electrodes have an ability to measure finer amplitude changes compared to ETT electrodes, may represent a safe method to deduce subtle EBSLN injuries, and may serve to optimize voice outcomes during thyroidectomy. CTM needle electrodes are safe and tolerated well.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>\n                      4\n                      <jats:italic>Laryngoscope<\/jats:italic>\n                      , 131:1436\u20131442, 2021\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.29413","type":"journal-article","created":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T02:21:54Z","timestamp":1612146114000},"page":"1436-1442","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Superior Laryngeal Nerve Signal Attenuation Influences Voice Outcomes in Thyroid Surgery"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1185-2041","authenticated-orcid":false,"given":"Ayaka J.","family":"Iwata","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Whitney","family":"Liddy","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Northwestern University Feinberg School of Medicine  Chicago Illinois U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcin","family":"Barczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Endocrine Surgery Third Chair of General Surgery, Jagiellonian University Medical College  Krakow Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1052-5348","authenticated-orcid":false,"given":"Che\u2010Wei","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5044-0325","authenticated-orcid":false,"given":"Tzu\u2010Yen","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology \u2013 Head and Neck Surgery Kaohsiung Medical University  Kaohsiung Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8292-9475","authenticated-orcid":false,"given":"Sam","family":"Van Slycke","sequence":"additional","affiliation":[{"name":"Department of General and Endocrine Surgery Onze\u2010Lieve\u2010Vrouw (OLV) Ziekenhuis Aalst  Aalst Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Surgery University Hospital Halle, Martin\u2010Luther\u2010University  Haller\u2010Wittenberg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0864-6087","authenticated-orcid":false,"given":"Gianlorenzo","family":"Dionigi","sequence":"additional","affiliation":[{"name":"Division for Endocrine and Minimally Invasive Surgery. Department of Human Pathology in Adulthood and Childhood \u201cG. Barresi\u201d University Hospital G. Martino, University of Messina  Messina Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henning","family":"Dralle","sequence":"additional","affiliation":[{"name":"Department of General Visceral and Transplantation Surgery, University of Duisburg\u2010Essen  Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio R.","family":"Cernea","sequence":"additional","affiliation":[{"name":"Department of Surgery Head and Neck Surgery Service of the Hospital das Cl\u00ednicas, University of Sao Paulo  Sao Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2765-5413","authenticated-orcid":false,"given":"Dipti","family":"Kamani","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr H.","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okenwa C.","family":"Okose","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1029-3954","authenticated-orcid":false,"given":"Bo","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Thyroid Surgery Fujian Medical University Union Hospital  Fujian China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5373-9181","authenticated-orcid":false,"given":"Gregory W.","family":"Randolph","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Massachusetts Eye and Ear Infirmary  Boston Massachusetts U.S.A."},{"name":"Department of Surgery Massachusetts General Hospital, Harvard Medical School  Boston Massachusetts 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