{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T11:07:37Z","timestamp":1792062457280,"version":"4.4.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Post-thyroidectomy syndrome (PTS), characterized by voice issues after thyroidectomy without recurrent laryngeal nerve injury, was investigated in this study. The Voice Fatigue Index (VFI) and cepstral analysis were employed for subjective and objective voice evaluation. Retrospective analysis involved 96 patients (37 males, 59 females) who underwent thyroidectomy without nerve injury from April 2018 to June 2022. Assessments pre- and post-thyroidectomy included the Voice Handicap Index (VHI) and VFI, along with auditory perceptual, acoustic (including cepstral), aerodynamic, and glottal vibration analyses. In females, although the GRBAS scale showed no significant change, both VHI and VFI increased post-thyroidectomy. Significant correlations were observed between the VHI and VFI in females. Acoustic analysis indicated a decrease in the cepstral peak prominence (CPP) of vowels (\/a\/) and sentences in females, with significant correlations between changes in the CPP\/a\/ and VHI\/VFI. The maximum fundamental frequency (F0max) exhibited a significant decrease, correlating with the VHI and VFI changes. The VFI demonstrated effectiveness in subjective PTS voice evaluation, comparable to the VHI. The present study highlights the potential of cepstral analysis as an index reflecting subjective voice discomfort, suggesting its promise for a comprehensive PTS voice evaluation.<\/jats:p>","DOI":"10.3390\/diagnostics14010111","type":"journal-article","created":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T04:05:38Z","timestamp":1704341138000},"page":"111","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Early Assessment of Voice Problems in Post-Thyroidectomy Syndrome Using Cepstral Analysis"],"prefix":"10.3390","volume":"14","author":[{"given":"Yeso","family":"Choi","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University of Medicine, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo Ram","family":"Keum","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University of Medicine, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju Eun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University of Medicine, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joong Seob","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Hallym Sacred Heart Hospital, Hallym University of Medicine, Anyang-si 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seok Min","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University of Medicine, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"IL-Seok","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Dongtan Sacred Heart Hospital, Hallym University of Medicine, Hwaseong 18450, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heejin","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology-Head and Neck Surgery, Hallym Sacred Heart Hospital, Hallym University of Medicine, Anyang-si 14068, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"ref_1","unstructured":"Center National Cancer Information (2022, January 02). Korean Cancer Registry Statistics. Available online: http:\/\/www.cancer.go.kr\/."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"4543","DOI":"10.1007\/s00405-016-4163-6","article-title":"Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment","volume":"273","author":"Tedla","year":"2016","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1016\/j.jamcollsurg.2004.06.020","article-title":"Voice changes after thyroidectomy without recurrent laryngeal nerve injury","volume":"199","author":"Sinagra","year":"2004","journal-title":"J. Am. Coll. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jvoice.2012.07.012","article-title":"Patient perspectives on dysphonia after thyroidectomy for thyroid cancer","volume":"27","author":"Kuhn","year":"2013","journal-title":"J. Voice"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1002\/lary.25452","article-title":"A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy","volume":"126","author":"Lang","year":"2016","journal-title":"Laryngoscope"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.surg.2013.03.011","article-title":"Extent of thyroidectomy affects vocal and throat functions: A prospective observational study of lobectomy versus total thyroidectomy","volume":"154","author":"Ryu","year":"2013","journal-title":"Surgery"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"297","DOI":"10.3342\/kjorl-hns.2014.57.5.297","article-title":"Post-Thyroidectomy Syndrome","volume":"57","author":"Hong","year":"2014","journal-title":"Korean J. Otorhinolaryngol.-Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/S0194-5998(97)70133-5","article-title":"Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury","volume":"117","author":"Myers","year":"1997","journal-title":"Otolaryngol. Head Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1044\/1058-0360.0603.66","article-title":"The voice handicap index (VHI) development and validation","volume":"6","author":"Jacobson","year":"1997","journal-title":"Am. J. Speech Lang. Pathol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1016\/S0892-1997(99)80010-1","article-title":"Validation of an instrument to measure voice-related quality of life (V-RQOL)","volume":"13","author":"Hogikyan","year":"1999","journal-title":"J. Voice"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jvoice.2014.09.012","article-title":"Vocal Fatigue Index (VFI): Development and validation","volume":"29","author":"Nanjundeswaran","year":"2015","journal-title":"J. Voice"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s00268-011-1347-5","article-title":"The importance of preoperative laryngeal examination before thyroidectomy and the usefulness of a voice questionnaire in screening","volume":"36","author":"Nam","year":"2012","journal-title":"World J. Surg."},{"key":"ref_13","unstructured":"Hirano, M. (1981). Clinical Examination of Voice, Springer."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/S0892-1997(02)00067-X","article-title":"The relationship between cepstral peak prominence and selected parameters of dysphonia","volume":"16","author":"Michael","year":"2002","journal-title":"J. Voice"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1080\/02699200400008353","article-title":"Toward the development of an objective index of dysphonia severity: A four-factor acoustic model","volume":"20","author":"Awan","year":"2006","journal-title":"Clin. Linguist. Phon."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1044\/jshr.3902.311","article-title":"Acoustic correlates of breathy vocal quality: Dysphonic voices and continuous speech","volume":"39","author":"Hillenbrand","year":"1996","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.jvoice.2016.12.011","article-title":"Subjective and objective voice assessments after recurrent laryngeal nerve-preserved total thyroidectomy","volume":"31","author":"Papadakis","year":"2017","journal-title":"J. Voice"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1080\/14417040701730990","article-title":"Vocal fatigue and its relation to vocal hyperfunction","volume":"10","author":"Solomon","year":"2008","journal-title":"Int. J. Speech Lang. Pathol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.jvoice.2019.01.010","article-title":"The relationship between vocal fatigue index and voice handicap index in university professors with and without voice complaint","volume":"34","author":"Moghtader","year":"2020","journal-title":"J. Voice"},{"key":"ref_20","first-page":"119","article-title":"Correlation between vocal fatigue index and voice handicap index scores in persons with laryngeal pathologies","volume":"2","author":"Afkhami","year":"2019","journal-title":"Func. Disabil. J."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Shulutko, A.M., Semikov, V.I., Moiseev, A.Y., Osmanov, E.G., Boblak, J.A., Patalova, A.R., Mansurova, G.T., and Kazaryan, A.M. Voice disorders after total thyroidectomy: Prospective evaluation by patient self-assessment, indirect laryngoscopy and ultrasonography. Indian J. Surg., 2022.","DOI":"10.1007\/s12262-022-03348-w"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/s40463-014-0028-4","article-title":"Prevalence of voice & swallowing complaints in pre-operative thyroidectomy patients: A prospective cohort study","volume":"43","author":"Holler","year":"2014","journal-title":"J. Otolaryngol. Head Neck Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1159\/000263673","article-title":"Vocal change associated with the use of atypical pitch and intensity levels","volume":"25","author":"Stone","year":"1973","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1159\/000265846","article-title":"Effects of speaking in noise on vocal fatigue and vocal recovery","volume":"39","author":"Neils","year":"1987","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.jvoice.2006.08.010","article-title":"Changes in objective acoustic measurements and subjective voice complaints in call center customer-service advisors during one working day","volume":"22","author":"Lehto","year":"2008","journal-title":"J. Voice"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1046\/j.1365-2273.1998.2360533.x","article-title":"Are voice endurance tests able to assess vocal fatigue?","volume":"23","author":"Buekers","year":"1998","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_27","unstructured":"Bogert, B.P., Healy, M.J., and Tukey, J.W. (1962, January 11\u201314). The frequency analysis of time series for echoes: Cepstrum, pseudo-autocovariance, cross-cepstrum and safe- cracking. Proceedings of the Symphosium on Time Series Analysis, Providence, RI, USA."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1109\/MSP.2004.1328092","article-title":"From frequency to quefrency: A history of the cepstrum","volume":"21","author":"Oppenheim","year":"2004","journal-title":"IEEE Signal Process. Mag."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1044\/jshr.3004.448","article-title":"A methodological study of perturbation and additive noise in synthetically generated voice signals","volume":"30","author":"Hillenbrand","year":"1987","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1044\/jshr.3901.126","article-title":"Comparison of voice analysis systems for perturbation measurement","volume":"39","author":"Bielamowicz","year":"1996","journal-title":"J. Speech Lang. Hear. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/j.1365-2273.2004.00846.x","article-title":"The reliability and sensitivity to change of acoustic measures of voice quality","volume":"29","author":"Carding","year":"2004","journal-title":"Clin. Otolaryngol. Allied Sci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1016\/j.jvoice.2009.12.010","article-title":"Cepstral analysis of voice in unilateral adductor vocal fold palsy","volume":"25","author":"Balasubramanium","year":"2011","journal-title":"J. Voice"},{"key":"ref_33","first-page":"63","article-title":"The utility of perturbation, non-linear dynamic, and cepstrum measures of dysphonia according to signal typing","volume":"6","author":"Choi","year":"2014","journal-title":"J. Korean Soc. Speech Sci."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1177\/000348940311200406","article-title":"Cepstral Peak Prominence: A More Reliable Measure of Dysphonia","volume":"112","author":"Michael","year":"2003","journal-title":"Ann. Otol. Rhinol. Laryngol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1121\/1.394382","article-title":"A model for vocal fold vibratory motion, contact area, and the electroglottogram","volume":"80","author":"Childers","year":"1986","journal-title":"J. Acoust. Soc. Am."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1007\/s004050100382","article-title":"Post-thyroidectomy superior laryngeal nerve injury","volume":"258","author":"Aluffi","year":"2001","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/S0892-1997(97)80020-3","article-title":"The role of strap muscles in phonation\u2014In vivo caninelaryngeal model","volume":"11","author":"Hong","year":"1997","journal-title":"J. Voice"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/111\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:39:40Z","timestamp":1760103580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/1\/111"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,4]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,1]]}},"alternative-id":["diagnostics14010111"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14010111","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,4]]}}}