Thyroid Surgery, Voice and the Laryngeal Examination—Time for Increased Awareness and Accurate Evaluation

The low risk of recurrent laryngeal nerve (RLN) injury frequently quoted to patients before thyroid surgery derives from expert series which are selectively reported. Rates of postoperative RLN paralysis increase substantial when postoperative laryngeal exam is performed routinely as opposed to selectively. Only routine pre- and postoperative laryngoscopy would allow individual surgeons/centers to know the exact incidence of RLN injury in their own practice. A surgeon knowing his own results, a clinical setting encouraging honest regular assessment/estimate of postoperative morbidity and an informed patient are all important contributors to improved outcome and diminished litigation after thyroid surgery.