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Voice Disorder Due to Iatrogenic FactorVOICENCT07131800

Objective and Perceptual Characteristics of the Voice After Endotracheal Intubation in Head and Neck Surgery

An observational study of Voice Disorder Due to Iatrogenic Factor and Endotracheal Intubation During Surgery, run by Clinical Hospital Centre Zagreb at 1 site in Croatia.

Enrolling by invitation

Enrolling by invitation. The study team selects and invites participants, usually from an existing group of patients.

Sites and contacts
Official record
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Trial summary

Introduction: Possible consequences of endotracheal intubation are post-intubation voice changes. Hypothesis: Endotracheal intubation during head and neck surgery is associated with objective and perceptual voice disorders. Read more about this study

Who is it for?
Ages 18 to 70 yearsHealthy volunteers can take part
How many people
180 participants
Where
1 siteCroatia
Study dates
25 Sep 2024to 30 Mar 2026
How long will I take part?
3 Months
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 70 years
  • All sexes
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: Patients scheduled for elective thyroid, head and neck surgery or abdominal surgery at the University Hospital Centre Zagreb. All eligible patients will be divided into three groups, as follows: patients scheduled for thyroid gland surgery; patients scheduled for some other type of head and neck operation that does not fall to exclusion criteria (parotidectomy, extirpation of congenital neck cyst, etc.); and control group including patients scheduled for operation other than the head and neck region. All operations will be performed by experienced operators with more than 100 annual procedures.

Who may be able to join

  • patients scheduled for elective thyroid, head and neck surgery or abdominal surgery
  • 18 and 70 years,
  • normal preoperative voice status, and
  • normal laryngeal status.

Who cannot join

  • <18 years in the time of surgery
  • history of previous head and neck operation or radiotherapy
  • patients scheduled for head and neck operation that can alter acoustic characteristics of the voice (surgery of the nasal cavity, ear surgery, laryngeal surgery, jaw surgery).
  • Patients with preoperatively diagnosed pathologic vocal cord findings (nodules, polyps, vocal cord paralysis),
  • patients with postoperative injuries of the vocal cords, recurrent and superior laryngeal nerve,
  • patients with laryngopharyngeal reflux,
  • patients in whom postoperative evaluation of the voice cannot be performed due to uncooperativeness will also be excluded from the study.

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Croatia1 site
  • University Hospital Centre Zagreb

    Zagreb, 10000

Other trials in Croatia

About this study

Introduction: Possible consequences of endotracheal intubation are post-intubation voice changes.

Hypothesis: Endotracheal intubation during head and neck surgery is associated with objective and perceptual voice disorders.

Read more

Research objective: To investigate the short-term and long-term effects of endotracheal intubation on voice quality during head and neck surgery.

Material, subjects, methodology and research design: A prospective observational cohort study that will include patients undergoing surgery and endotracheal intubation lasting up to 3 hours. Adult patients divided into three groups will be included in the research: thyroid surgery, parotid gland surgery and abdominal surgery. Videostroboscopy, perceptual and objective acoustic voice analysis will be recorded before surgery, on the second postoperative day, two weeks and 1 month after surgery.

Expected scientific contribution of the proposed research: The scientific contribution would be an understanding of the risk factors and the connection of voice disorders after endotracheal intubation, as well as the ability to determine differences in this risk in patients undergoing different operations.

Read the detailed description

study protocol has been published and is attached below

Keywords
endotracheal intubation, surgery, head and neck, voice disorder, VHI
Medical subject headings
Voice Disorders

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

Study groups in NCT07131800
Study groupRoleWhat they receive
Patients undergoing thyroid surgeryPatients undergoing scheduled thyroid surgery at the University Hospital Centre Zagreb under general endotracheal anesthesia without preoperative voice disorder regardless of the cause (previous operations or irradiation on the neck, and damage to the recurrent laryngeal nerve (RLN) during thyroidectomy).
Patients undergoing abdominal surgeryPatients undergoing scheduled abdominal surgery at Day surgery of University Hospital Centre Zagreb under general anesthesia without preoperative voice disorder regardless of the cause (previous operations or irradiation on the neck, and damage to the recurrent laryngeal nerve (RLN) during thyroidectomy). This will include laparoscopic abdominal procedures and other minor abdominal procedures done in Day surgery, and will be control group for head and neck surgical procedures.
Patients undergoing other head and neck surgery besides thyroidPatients undergoing scheduled head and neck surgeries beside thyroid surgery at the University Hospital Centre Zagreb under general endotracheal anesthesia without preoperative voice disorder regardless of the cause (previous operations or irradiation on the neck, and damage to the recurrent laryngeal nerve (RLN) during thyroidectomy).

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Subjective analysis of voice changes before and after endotracheal intubation for thyroid surgery, other head and neck surgery and abdominal surgery using Voice Handicap Index (VHI)

    The Voice Handicap Index (VHI) is one of the most frequently used self-assessment scales for voice disorders. The Croatian version was adapted and validated by Bonetti and Bonetti (2013), while Benšić et al. (2024) confirmed normative values for the Croatian language. The scale consists of 30 items divided into three subscales:

    • Functional, emotional and physical component. Each item is rated on a 5-point Likert scale (0 = Never, 1 = Almost Never, 2 = Sometimes, 3 = Almost Always, 4 = Always), giving a total score from 0 to 120, with higher scores indicating greater perceived voice handicap. Participants will complete the VHI questionnaire at Baseline (within 7 days before surgery with endotracheal intubation) and at postoperative follow-up time points (Day 1, Week 2, and Week 4).

    The primary VHI outcome is the change in total score before and after surgery.

    Units of Measure:

    • Total score range: 0-120

    Method of Administration:

    • Self-administered paper

    Measured: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

  2. Subjective analysis of voice changes before and after endotracheal intubation for thyroid surgery, other head and neck surgery and abdominal surgery using GRBAS Scale (Perceptual Voice Evaluation)

    The perceptual voice assessment (GRBAS) will be conducted by two speech-language pathologists with several years of clinical experience. Each parameter-Grade, Roughness, Breathiness, Asthenia, and Strain-will be scored on a 4-point scale (0 = Normal, 1 = Slight, 2 = Moderate, 3 = Severe). The average of the two evaluators' scores will be taken, and in the case of significant discrepancies, a third evaluator will be consulted to reach consensus.

    Voice samples will be recorded at baseline and post-intervention at 4 time points total. The primary GRBAS outcome will be the change in the 'Grade' score; secondary analyses will include changes in R, B, A, and S.

    Units of Measure:

    • Ordinal scores (0-3) for each parameter

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

  3. Videostroboscopy Evaluation before and after surgery

    Videostroboscopy uses an endoscope containing a built-in video camera and a stroboscope, which records phonation while the vocal cords are being filmed. The recording captures the frequency of vocal cord vibrations during voice production and provides an apparently slow-motion view of these vibrations. In the stroboscopic video, the movements of the vocal cords are slowed down enough to precisely follow their motion. This technique allows detailed observation of the amplitude and symmetry of vibrations, as well as the phase of vocal cord closure during voice production. It facilitates diagnosis of numerous physical problems with the vocal cords, including paresis resulting from injury to the recurrent laryngeal nerve. Evaluations will be performed pre- and post-intervention using a standardized protocol. 2 experienced phoniatrists will independently review the recordings to identify possible pathology in vocal fold motion or structural damage. No formal scoring system will be applied.

    Measured: Preoperative (within 7 days before surgery) and Postoperative day 1

  4. Objective Acoustic and Aerodynamic Voice Analysis - changes in fundamental frequency before and after surgery

    Objective voice evaluation will be performed using selected acoustic and aerodynamic measures. Voice assessment involves recording sustained phonation of the vowel /a/ in a sound-treated room using a calibrated digital recording system. The recordings will be acquired with a high-quality microphone positioned at a fixed distance of 30 cm from the participant's mouth, placed at a 45° angle. The sound signal will be analyzed using the LingWAVES SLP Suite Pro VPR software (WEVOSYS medical technology GmbH, Germany). This software converts the analog voice signal to digital form and processes it to extract relevant voice parameters.

    Parameters to be evaluated:

    • Fundamental frequency (F0) in Hz.

    Physiological reference values:

    • Fundamental frequency: Female: ~206 Hz, Male: ~120 Hz,

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

Secondary outcomes (4)
  1. Objective Acoustic and Aerodynamic Voice Analysis - changes in Intensity before and after surgery

    Objective voice evaluation will be performed using selected acoustic and aerodynamic measures. Voice assessment involves recording sustained phonation of the vowel /a/ in a sound-treated room using a calibrated digital recording system. The recordings will be acquired with a high-quality microphone positioned at a fixed distance of 30 cm from the participant's mouth, placed at a 45° angle.

    The sound signal will be analyzed using the LingWAVES SLP Suite Pro VPR software (WEVOSYS medical technology GmbH, Germany). This software converts the analog voice signal to digital form and processes it to extract relevant voice parameters.

    Parameters to be evaluated:

    • Intensity (in dB)

    Physiological reference values:

    • Intensity: Female: 68-74 dB, Male: 68-76 dB

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

  2. Objective Acoustic and Aerodynamic Voice Analysis- changes in Jitter before and after surgery

    Objective voice evaluation will be performed using selected acoustic and aerodynamic measures. Voice assessment involves recording sustained phonation of the vowel /a/ in a sound-treated room using a calibrated digital recording system. The recordings will be acquired with a high-quality microphone positioned at a fixed distance of 30 cm from the participant's mouth, placed at a 45° angle.

    The sound signal will be analyzed using the LingWAVES SLP Suite Pro VPR software (WEVOSYS medical technology GmbH, Germany). This software converts the analog voice signal to digital form and processes it to extract relevant voice parameters.

    Parameters to be evaluated:

    • Jitter (%)

    Physiological reference values:

    • Jitter: 0-0.5%

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

  3. Objective Acoustic and Aerodynamic Voice Analysis- changes in shimmer before and after surgery

    Objective voice evaluation will be performed using selected acoustic and aerodynamic measures. Voice assessment involves recording sustained phonation of the vowel /a/ in a sound-treated room using a calibrated digital recording system. The recordings will be acquired with a high-quality microphone positioned at a fixed distance of 30 cm from the participant's mouth, placed at a 45° angle.

    The sound signal will be analyzed using the LingWAVES SLP Suite Pro VPR software (WEVOSYS medical technology GmbH, Germany). This software converts the analog voice signal to digital form and processes it to extract relevant voice parameters.

    Parameters to be evaluated:

    • Shimmer (%)

    Physiological reference values:

    • Shimmer: 0-5%

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

  4. Objective Acoustic and Aerodynamic Voice Analysis- changes in Maximum phonation time before and after surgery

    Objective voice evaluation will be performed using selected acoustic and aerodynamic measures. Voice assessment involves recording sustained phonation of the vowel /a/ in a sound-treated room using a calibrated digital recording system. The recordings will be acquired with a high-quality microphone positioned at a fixed distance of 30 cm from the participant's mouth, placed at a 45° angle.

    The sound signal will be analyzed using the LingWAVES SLP Suite Pro VPR software (WEVOSYS medical technology GmbH, Germany). This software converts the analog voice signal to digital form and processes it to extract relevant voice parameters.

    Parameters to be evaluated:

    • Maximum phonation time (MPT, in seconds)

    Physiological reference values:

    • Maximum phonation time: Female: 15-25 sec, Male: 25-35 sec

    Measured: Time Points: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted20 Aug 2025
  2. Study start25 Sep 2024
  3. Primary completion31 Dec 2025 (estimated)
  4. Study completion30 Mar 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
180 participants (estimated)
Target duration
3 Months
IDs, dates and publications
ClinicalTrials.gov ID
NCT07131800
Sponsor's protocol ID
Klasa8.1-23/209-3;Broj02/013AG
Acronym
VOICE
Status last verified
Aug 2025
First submitted
8 Jul 2025
Last updated
20 Aug 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: At the moment, we do not know other logopedic laboratory being able to perform the same audiometric evaluation.

Publications

  • Simic I, Curic Radivojevic R, Slipac J, Prgomet D. VOICE CONDITION FOLLOWING SHORT-TERM ENDOTRACHEAL INTUBATION IN HEAD AND NECK SURGERY: STUDY PROTOCOL FOR CLINICAL TRIAL. Acta Clin Croat. 2023 Apr;62(Suppl1):49-54. doi: 10.20471/acc.2023.62.s1.06.

    PubMed 38746618

Questions about this trial

What is this clinical trial studying?

An observational study of Voice Disorder Due to Iatrogenic Factor and Endotracheal Intubation During Surgery, run by Clinical Hospital Centre Zagreb at 1 site in Croatia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 7 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: enrolling by invitation, as of the sponsor's last update on 20 Aug 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Croatia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Subjective analysis of voice changes before and after endotracheal intubation for thyroid surgery, other head and neck surgery and abdominal surgery using Voice Handicap Index (VHI) (time frame: Preoperative (within 7 days before surgery), Postoperative Day 1, Week 2, and Week 4). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT07131800, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Aug 2025.

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