Effects of Dysphagia Therapy on Swallowing Dysfunction after Total Thyroidectomy

Document Type : Original


1 Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

2 Department of Clinical Sciences, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

3 Rehabilitation Research Center, Department of Speech and Language Pathology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.

4 Department of Biostatics, School of Management and Information, Iran University of Medical Sciences, Tehran, Iran.

5 Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences.


Swallowing disorder or dysphagia is a common complication after conventional total thyroidectomy. Traditional dysphagia therapy (TDT) has long been a routine rehabilitation program for patients with dysphagia; however, there is no evidence to support the efficacy of this approach in patients with post-thyroidectomy dysphagia. Regarding this, the purpose of the current study was to explore the effectiveness of TDT in swallowing dysfunction in patients suffering from post-thyroidectomy dysphagia.
Materials and Methods:
This pilot clinical trial was conducted on 21 patients with post-thyroidectomy dysphagia. The study population was randomly assigned into two groups of TDT and control. The patients in the TDT group received 18 treatment sessions for 6 weeks, 3 times a week. The Swallowing Impairment Score (SIS-6), Functional Oral Intake Scale (FOIS), and Persian Dysphagia Handicap Index (P-DHI) were the outcome measures. The outcome variables were assessed at the baseline, at the end of the treatment, and after a 6-week follow-up. The main effects of time and group and their interaction effect on SIS-6 and P-DHI scores were examined using repeated measures ANOVA. In addition, the intergroup comparison in terms of the FOIS score was analyzed using the Mann-Whitney U test. The Cohen's d effect size was also measured to ascertain the effects of the treatment.
According to the results, the TDT group showed a significant improvement in the SIS-6, FOIS and P-DHI scores over time (P<0.001). The results also revealed that the interaction effect of time and group was significant on SIS-6 and P-DHI scores (P<0.001). In addition, effect sizes on SIS-6, FOIS, and P-DHI scores were large in the TDT group.
This study suggested that TDT could improve the swallowing dysfunction in the patients suffering from post-thyroidectomy dysphagia. As the results indicated, the improvements persisted 6 weeks after the end of TDT.


Main Subjects

  1. Grover G, Sadler GP, Mihai R. Morbidity after thyroid surgery: patient perspective. The Laryngoscope, 2013. 123(9): p. 2319-23.
  2. Pereira JA, Girvent M, Sancho JJ, Parada C, Sitges-Serra A. Prevalence of long-term upper aerodigestive symptoms after uncomplicated bilateral thyroidectomy.Surgery,2003.133(3):p.      318-22.
  3. Park YM, Ho-Oh K, Cho JG, Beak SK, Kwon SY, Jung KY, et al. Changes in Voice-and Swallowing-Related Symptoms After Thyroidectomy: One-Year Follow-Up Study. Annals of Otology, Rhinology & Laryngology,2018.127 (3): p. 171-7.
  4. Lombardi CP, Raffaelli M, Alatri MD, Marchese MR, Rigante M, Paludetti G, et al. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery, 2006. 140(6): p. 1026-34.
  5. Krekeler BN, Wendt E, Macdonald C, Orne J, Francis DO, Sippel R, et al. Patient-Reported Dysphagia After Thyroidectomy: A Qualitative Study. JAMA Otolaryngology–Head & Neck Surgery, 2018. 144(4): p. 342-8.
  6. Arakawa-Sugueno L, Ferraz AR, Morandi J, Capobianco DM, Cernea CR, Sampaio MA, et al. Videoendoscopic evaluation of swallowing after thyroidectomy:7 and 60 days.Dysphagia,2015.30(5): p. 496-505.
  7. Ekberg O. Dysphagia: Diagnosis and treatment. 2012: Springer Science & Business Media.
  8. Scerrino G, Inviati A, Giovanni SD, Paladino NC, Paola VD, Re GL, et al. Esophageal motility changes after thyroidectomy; possible associations with postoperative voice and swallowing disorders: preliminary results. Otolaryngology–Head and Neck Surgery, 2013. 148(6): p. 926-32.
  9. Bou-Malhab F, Hans S, Laccourreye O, Brasnu D. Swallowing disorders in unilateral recurrent laryngeal nerve paralysis. in Annales d'oto-laryngologie et de chirurgie cervico faciale: bulletin de la Societe d'oto-laryngologie des hopitaux de Paris. 2000.
  10. Randolph GW. Surgical anatomy of the recurrent laryngeal nerve. Surgery of the thyroid and parathyroid glands, 2003: p. 300-2.
  11. Rosato L, Avenia N, Bernante P, Palma MD, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World journal of surgery, 2004. 28(3): p. 271-6.
  12. Hyun K, Byon W, Park HJ, ParK Y, Park C, Yun JS. Comparison of swallowing disorder following gasless transaxillary endoscopic thyroidectomy versus conventional open thyroidectomy. Surgical endoscopy, 2014.28(6): p. 1914-20.
  13. Tae K, Kim KY, Yun BR, Ji YB, Prak CW, Kim DS, et al. Functional voice and swallowing outcomes after robotic thyroidectomy by a gasless unilateral axillo-breast approach: comparison with open thyroidectomy. Surgical endoscopy, 2012. 26(7): p. 1871-7.
  14. Exarchos S, Lachanas VA, Tsiouvaka S, Tsea M, Hajiioannou JK, Skoulakis CE, Bizakis JB. The impact of perioperative dexamethasone on swallowing impairment score after thyroidectomy: a retrospective study of 118 total thyroidectomies. Clinical Otolaryngology, 2016. 41(5): p. 615-18.
  15. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. stroke, 2005. 36(12): p. 2756-63.
  16. Garcia-Peris P, Paron L, Velasco C, de la Cuerda C, Camblor M, Breton I, et al. Long-term prevalence of oropharyngeal dysphagia in head and neck cancer patients: impact on quality of life. Clinical Nutrition, 2007. 26(6): p. 710-17.
  17. Finestone HM, Greene-Finestone LS. Rehabilitation medicine: 2. Diagnosis of dysphagia and its nutritional management for stroke patients. Canadian Medical Association Journal, 2003. 169(10): p. 1041-4.
  18. Logemann JA. The evaluation and treatment of swallowing disorders. Current Opinion in Otolaryngology & Head and Neck Surgery, 1998. 6(6): p. 395-400.
  19. Nagaya M, Kachi T, Yamada T. Effect of swallowing training on swallowing disorders in Parkinson's disease. Scandinavian journal of rehabilitation medicine, 2000. 32(1): p. 11-15.
  20. Tarameshlu M, Ghelichi L, Azimi AM, Nakhostin-Ansari N, Khatoonabadi AR. The effect of traditional dysphagia therapy on the swallowing function in patients with Multiple Sclerosis: A pilot double-blinded randomized controlled trial. Journal of Bodywork and Movement Therapies, 2019. 23(1): p.171-9.
  21. Govender R, Wood CE, Tylor SA, Smith CH, Barratt H, Gardner B. Patient experiences of swallowing exercises after head and neck cancer: A qualitative study examining barriers and facilitators using behaviour change theory. Dysphagia, 2017. 32(4): p. 559-69.
  22. Ghelichi L, Joghataei MT, Jalaie S, Nakhostin-Ansari N, Forogh B, Mehrpour M. A single-subject study to evaluate the inhibitory repetitive transcranial magnetic stimulation combined with traditional dysphagia therapy in patients with post-stroke dysphagia. Iranian journal of neurology, 2016. 15(3): p. 140.
  23. Bakhtiyari J, Sarraf P, Nakhostin-Ansari N, Tafakhori A, Logemann J, Faghihzadeh S, et al. Effects of early intervention of swallowing therapy on recovery from dysphagia following stroke. Iranian journal of neurology, 2015. 14(3): p. 119.
  24. Lombardi CP, Raffaelli M, Dalatri L, Crea CD, Marchese MR, Maccora D, et al. Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World Journal of Surgery, 2008. 32(5): p. 693-700.
  25. Crary MA, Mann GDC, Groher ME. Initial psychometric assessment of a functional oral intake scale for dysphagia in stroke patients. Archives of physical medicine and rehabilitation, 2005. 86(8):
    p. 1516-20.
  26. Asadollahpour F, Baghban K, Asadi M. Validity and reliability of the persian version of the dysphagia handicap index (DHI). Iranian journal of otorhinolaryngology, 2015. 27(80): p. 185.
  27. Silbergleit AK, Schultz L, Jacobson BH, Beardsley T, Johnson AF. The Dysphagia handicap index: development and validation. Dysphagia, 2012. 27(1): p. 46-52.