Effects of Therapeutic Exercise With and Without Nerve Stimulation on Dysphonia in Post Thyroidectomy Patients

This clinical trial evaluates rehabilitation strategies for post-thyroidectomy dysphonia. Voice impairment is a frequent complication following thyroid surgery. It often occurs even without direct laryngeal nerve transection. Surgical trauma, tissue edema, and mechanical stretching of the laryngeal nerves or surrounding musculature can cause persistent voice changes. These changes significantly lower a patient's quality of life.This study compares two distinct interventions against standard care:Therapeutic Voice and Neck Exercise AloneTherapeutic Voice and Neck Exercise Combined with Transcutaneous Electrical Nerve Stimulation (TENS)The objective is to determine if adding non-invasive nerve stimulation to standard therapeutic exercises accelerates neuromuscular recovery, improves vocal fold mobility, and enhances overall voice quality more effectively than exercise alone. Background and Rationale Thyroidectomies are common surgical procedures worldwide. Dysphonia post-surgery stems from multiple factors. These include temporary or permanent recurrent laryngeal nerve (RLN) neuropraxia, external branch of the superior laryngeal nerve (EBSLN) injury, laryngotracheal fixation, and peri laryngeal scarring. Patients frequently report hoarseness, vocal fatigue, reduced pitch range, and breathiness. Standard management typically includes watchful waiting or traditional voice therapy. Therapeutic exercises aim to stretch scarred tissues, strengthen paretic intrinsic laryngeal muscles, and optimize respiratory support. Transcutaneous Electrical Nerve Stimulation (TENS) uses low-voltage electrical currents to stimulate peripheral nerves. TENS is hypothesized to reduce local pain, increase regional blood flow, decrease muscle tension, and facilitate neural regeneration when applied to the anterior neck. By combining these therapies, this trial investigates whether sensory and motor electrical stimulation acts synergistically with active physical and vocal exercises. The goal i