Neuromuscular electrophonopedic stimulation of the larynx after surgical treatment of patients with differentiated thyroid cancer
- Authors: Vyazmenov E.O.1,2, Polunin M.M.2, Slashchuk K.Y.1, Beltsevich D.G.3, Katsobashvili I.A.3, Shotik J.V.3, Sardaeva D.G.3, Mokrysheva N.G.3
-
Affiliations:
- Endocrinology Research Centre
- N.I. Pirogov Russian National Research Medical University
- Endocrinology Research Center
- Issue: Vol 29, No 2 (2023)
- Pages: 83-90
- Section: Original Research Articles
- URL: https://medjrf.com/0869-2106/article/view/123149
- DOI: https://doi.org/10.17816/medjrf123149
Cite item
Abstract
BACKGROUND: Thyroid cancer is the most common endocrine malignancy, accounting for 3.4% of all cancers diagnosed annually. Differentiated thyroid cancer (DTC) is primarily treated with surgery, which can often involve complications such as postoperative pareses or reversible laryngeal nerve (RLN) paralysis. Currently, rehabilitation possibilities for patients with postoperative RLN pairs are relevant. In this study, we used neuromuscular electrostimulation with vocaSTIM in combination with drug therapy and evaluated the effectiveness of the rehabilitation.
AIMS: To determine the possibility of using neuromuscular electrophonopathic laryngeal stimulation (NMELS) in restoring laryngeal function after surgical treatment of DTC complicated by pareses/paralysis of thr RLN.
MATERIALS AND METHODS: Seventy-six patients with DTC who have undergone surgical treatment, complicated by paresis of RLN, were enrolled in this study.
RESULTS: The study analyzed the treatment results of these 76 patients. The age of the patients ranged from 6 to 78 (average age, 47) years, the female-to-male ratio was 59 to 17 (women, 77.6%; men, 22.4%). Postoperative unilateral laryngeal paresis was present in 56 patients (73.68%) and bilateral lesions in 20 (26.32%). Phonation violation was found in all patients: dysphonia, 76 (100%); dysphagia, 28 (36.84%); and respiratory failure, 11 (14.47%), and 2 patients (2.63%) were tracheotomized postoperatively. All patients underwent neuro-phonic rehabilitation with mandatory assessment and video fixation of laryngeal function. As a result of neuromuscular electrophonopathic stimulation of the larynx, 69 out of 76 patients (90.79%) had improved larynx function.
CONCLUSIONS: Based on our experience, NMELS with vocaSTIM can be used for restoring the functions of the larynx in patients with RLN paresis of varying severities, after surgical treatment for DTC.
Full Text

About the authors
Eduard O. Vyazmenov
Endocrinology Research Centre; N.I. Pirogov Russian National Research Medical University
Email: hnodoctor@gmail.com
ORCID iD: 0000-0002-2880-4882
SPIN-code: 4838-5368
MD, Cand. Sci. (Med.), associate professor
Russian Federation, 11 Dmitry Ulyanov street, 117292 Moscow; MoscowMikhail M. Polunin
N.I. Pirogov Russian National Research Medical University
Email: mmpolunin@gmail.com
ORCID iD: 0000-0002-9086-726X
SPIN-code: 1199-4723
MD, Dr. Sci. (Med.), professor
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowKonstantin Y. Slashchuk
Endocrinology Research Centre
Email: slashuk911@gmail.com
ORCID iD: 0000-0002-3220-2438
SPIN-code: 3079-8033
MD, Cand. Sci. (Med.), research associate
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowDmitry G. Beltsevich
Endocrinology Research Center
Email: belts67@gmail.com
ORCID iD: 0000-0001-7098-4584
SPIN-code: 4475-6327
MD, Dr. Sci. (Med.), chief research associate
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowIlana A. Katsobashvili
Endocrinology Research Center
Email: kacobashvili.ilana@mail.ru
ORCID iD: 0000-0002-4388-6097
SPIN-code: 7274-3990
resident
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowJulia V. Shotik
Endocrinology Research Center
Email: vika281095@mail.ru
ORCID iD: 0000-0001-9678-5794
resident
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowDaria G. Sardaeva
Endocrinology Research Center
Email: sardaieva96@mail.ru
ORCID iD: 0000-0001-9418-1786
resident
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowNataliya G. Mokrysheva
Endocrinology Research Center
Author for correspondence.
Email: mokrisheva.natalia@endocrincentr.ru
ORCID iD: 0000-0002-9717-9742
SPIN-code: 5624-3875
MD, Dr. Sci. (Med.), professor, member of Russian Academy of Sciences
Russian Federation, 11 Dmitry Ulyanov street, 117292, MoscowReferences
- Prete A, Borges de Souza P, Censi S, et al. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol. 2020:11:102. doi: 10.3389/fendo.2020.00102
- Stewart LA, Kuo JH. Advancements in the treatment of differentiated thyroid cancer. Ther Adv Endocrinol Metab. 2021;12: 20420188211000251. doi: 10.1177/20420188211000251
- Luster M, Clarke SE, Dietlein M, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35(10):1941–1959. doi: 10.1007/s00259-008-0883-1
- Medas F, Canu GL, Boi F, et al. Predictive factors of recurrence in patients with differentiated thyroid carcinoma: a retrospective analysis on 579 patients. Cancers (Basel). 2019;11(9):1230. doi: 10.3390/cancers11091230
- Panh J. Basis und konzeption der therapie von larynxparesen durch neuromuskulare elektrophonatorische stimulation (NMEPS). Kurze einfmhrung in die therapie von larynxparesen, aphasie, dysphasie und dysartrie mit dem Gerltekonzept vocaSTIM. 2002. 24 p.
- Cirocchi R, Arezzo A, D’Andrea V, et al. Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery. Cochrane Database Syst Rev. 2019;1(1):CD012483. doi: 10.1002/14651858.CD012483.pub2
- Addasi N, Fingeret A, Goldner W. Hemithyroidectomy for thyroid cancer: a review. Medicina (Kaunas). 2020;56(11):586. doi: 10.3390/medicina56110586
- Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009;96(3):240–246. doi: 10.1002/bjs.6417
- Lynch J, Parameswaran R. Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: a review. Head Neck. 2017;39(7):1470–1478. doi: 10.1002/hed.24772
- Krasnodębska P, Domeracka-Kołodziej A, Szkiełkowska A, et al. Assessment of short-term functional voice therapy in patients with unilateral paralysis of the larynx. Otolaryngol Pol. 2018;72(2):36–34. doi: 10.5604/01.3001.0011.7250
- Kosztyła-Hojna B, Moskal D, Rogowski M, et al. The usage of modern physioterapeutic methods of rehabilitation in treatment of chosen kinds of dysphonia. Otolaryngol Pol. 2012;66(5):328–336. doi: 10.1016/j.otpol.2012.06.020
- Shelesko EV, Abdulgamidov AH, Chernikova NA, et al. Electrical stimulation for paresis of the larynx and pharynx. Literature review. Evrazijskij nauchnyj zhurnal. 2021;(7): 3–10. (In Russ).
- Hyman A. Resuscitation of the stopped heart in intracardial therapy. II. Experimental use of an artificial pacemaker. American Heart Journal. 1933;8(4):563–564. doi: 10.1016/s0002-87 03(33)9067
- Zealear DL, Rainey CL, Herzon GD, et al. Electrical pacing of the paralyzed human larynx. Ann Otol Rhinol Laryngol. 1996;105(9): 689–693. doi: 10.1177/000348949610500904
- Bedareva NA, Evnevich GV. The use of neuromuscular stimulation of laryngeal muscles with the vocaSTIM apparatus for the treatment of bulbar disorders. Russian journal of physiotherapy, balneology and rehabilitation. 2013;5:45–46. (In Russ).
- Shilenkova VV, Filatova EA, Korotchenko VV. Reabilitacija golosa u bol’nyh gipotonusnoj disfoniej metodom nejromyshechnoj jelektrofonopedicheskoj stimuljacii gortani. Rossijskaja otorinolaringologija. 2007;(2):121–125. (In Russ).
- Stepanova JE, Gotovyahina TV, Mokhotaeva MV, Mahotkina NN. Complex rehabilitation of patients with unilateral vocal fold paresis after thyroid surgery (medical and pedagogical recommendations). Russian otorhinolaryngology. 2014;4:131–137. (In Russ).
- Kryukov AI, Romanenko SG, Pavlikhin OG, Lesogorova EV. Clinical and functional state of the larynx in older patients with chronic edematous-polypous laryngitis. Bulletin of otorhinolaryngology. 2018;83(1):56–58. (In Russ). doi: 10.17116/otorino201883156-58
Supplementary files
