ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2026
Balancing hemostasis and function: the impact of hemostatic materials on voice and swallowing outcomes in nerve-preserved thyroidectomy.
Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
Abstract
objectivePost-thyroidectomy dysphonia may occur even when recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) integrity are preserved. Hemostatic materials (HMs) are widely used to enhance intraoperative hemostasis and reduce postoperative drainage; however, their use may introduce a functional trade-off between bleeding control and postoperative voice and swallowing outcomes. This study aimed to evaluate how different HMs balance hemostatic efficacy and functional preservation in nerve-preserved total thyroidectomy.
methodsThis retrospective study included adult patients who underwent primary nerve-preserved total thyroidectomy with standardized intraoperative neuromonitoring (IONM). Patients were categorized into three groups according to HM use: no hemostatic material (NHM), fibrin sealant (Tisseel, TIS), and polysaccharide-based agent (4DryField PH, 4DF). Objective voice parameters and subjective voice and swallowing assessments were obtained preoperatively and at six weeks postoperatively.
results175 patients were analyzed (NHM:74/TIS:30/4DF:71), with comparable demographic, surgical, and pathological characteristics among groups. TIS provided the most robust hemostatic effect, with 0% drain placement, but was associated with significantly greater deterioration in pitch-related voice parameters and patient-reported voice outcomes. In contrast, 4DF showed postoperative voice outcomes comparable to NHM and demonstrated a significantly lower incidence of swallowing impairment (p = 0.007).
conclusionIn nerve-preserved total thyroidectomy, hemostatic efficacy and functional preservation exist along a balance rather than a binary choice. Tisseel provides superior bleeding control through robust tissue sealing, however, their strong mechanical restriction on key extralaryngeal muscles may compromise postoperative voice function. 4DF achieves adequate hemostasis while preserving voice and swallowing function. These findings support a personalized, anatomy-aware selection of hemostatic materials, emphasizing functional priorities and precise avoidance of critical voice-related structures, rather than routine or uniform application.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.