Intraoperative Laryngeal Electromyography in Children With Vocal Fold Immobility<subtitle>Results of a Multicenter Longitudinal Study</subtitle>

Objectives: Diagnostic and management strategies for adult unilateral vocal fold immobility (UVFI) vary among otolaryngologists. The aim of this study was to determine the current attitudes and practices regarding laryngeal electromyography (LEMG) for the management of adult UVFI within a cohort of subspecialty laryngologists. Methods: A 19-item instrument focused on diagnosis and management of adult UVFI was mailed to active members (n = 249) of the American Broncho-Esophagological Association (ABEA). The subset of questions related to LEMG is reviewed in this report. Statistical analysis using a χ2 test was performed. Results: The survey response rate was 34% (n = 84), with 8 surveys returned incomplete because of pediatric-limited practices. Of the respondents, 75% (n = 57) rely on LEMG for evaluation of UVFI, whereas 25% (n = 19) do not use LEMG. Of those who use LEMG, 54% place their own electrodes and 44% interpret the LEMG results themselves. Monopolar electrodes are used by 57% (n = 25), bipolar electrodes by 27% (n = 12), and hooked-wire electrodes by 17% (n = 7). Muscles evaluated by LEMG include the thyroarytenoid (100%), cricothyroid (94%), posterior cricoarytenoid (70%), lateral cricoarytenoid (43%), cricopharyngeus (27%), and interarytenoid (17%). The LEMG is performed in an unblinded fashion by most respondents (85%), and many (66%) feel a more accurate result is obtained when clinical information is known. There was no statistically significant difference in use of LEMG, placement of electrodes, and interpretation of LEMG according to percentage of laryngology practice. Conclusions: The survey results demonstrate congruence among ABEA members in the utility of LEMG in the management of adult UVFI. Some variability was noted in the methods by which LEMG is performed and interpreted.

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Diagnostic limitation of laryngostroboscopy in comparison to laryngeal electromyography in synkinesis in unilateral vocal fold paralysis

European Archives of Oto-Rhino-Laryngology ◽

10.1007/s00405-021-06714-8 ◽

2021 ◽

Author(s):

Isabella Stanisz ◽

Matthias Leonhard ◽

Doris-Maria Denk-Linnert ◽

Berit Schneider-Stickler

Keyword(s):

Retrospective Study ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Laryngeal Nerve ◽

Unilateral Vocal Fold Paralysis ◽

Laryngeal Electromyography ◽

Therapy Failure ◽

Clinical Routine ◽

Length Difference ◽

Vocal Fold Immobility

Abstract Purpose In clinical practice, laryngo(strobo)scopy (LS) is still mainly used for diagnostics and management of unilateral vocal fold paralysis (UFVP), although only laryngeal electromyography (LEMG) can provide information on causes of vocal fold immobility, especially on possible synkinetic reinnervation after recurrent laryngeal nerve (RLN) injury. The goal of this retrospective study was the evaluation whether signs of synkinetic reinnervation in LS can be objectified in comparison to LEMG data. Methods Between 1/2015 and 2/2018, 50 patients with laryngostroboscopically suspected UVFP received routine LEMG examination. The LEMG findings were retrospectively compared with LS findings. The LEMG data analysis focused on the diagnosis of synkinetic reinnervation of the TA/LCA and/or PCA. The digital LS recordings were retrospectively re-evaluated by phoniatricians considering 22 selected laryngostroboscopic parameters. Results LEMG revealed synkinesis in 23 (46%) and absence of synkinesis in 27 (54%) patients. None of the 22 parameters showed significant association between patients with synkinetic reinnervation and LS findings. The only laryngostroboscopic parameter that was significantly associated with a silent LEMG signal compared to single fiber activity in LEMG was a length difference on the side of the UVFP (p-value 0.0001; OR 14.5 (95% CI 3.047–66.81; Sensitivity 0.5; Specificity 0.9355). Conclusion Our findings show that synkinesis cannot be diagnosed using only LS. This study underlines the importance of LEMG in clinical routine for detection of laryngeal synkinesis in patients with UVFP before any further therapeutic steps are initiated to avoid later therapy failure.

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The Role of Laryngeal Electromyography in Vocal Fold Immobility

ORL ◽

10.1159/000077226 ◽

2004 ◽

Vol 66 (1) ◽

pp. 5-10 ◽

Cited By ~ 9

Author(s):

Badr Eldin Mostafa ◽

Naglaa Ali Gadallah ◽

Nagwa Mohammad Nassar ◽

Hassan Mohammad Al Ibiary ◽

Hanan Ahmed Fahmy ◽

...

Keyword(s):

Vocal Fold ◽

Laryngeal Electromyography ◽

Vocal Fold Immobility

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Value of Laryngeal Electromyography in Diagnosis of Vocal Fold Immobility

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348940711600804 ◽

2007 ◽

Vol 116 (8) ◽

pp. 576-581 ◽

Cited By ~ 28

Author(s):

Wen Xu ◽

Demin Han ◽

Lizhen Hou ◽

Li Zhang ◽

Gongwei Zhao

Keyword(s):

Vocal Fold ◽

Motor Unit Potential ◽

Laryngeal Electromyography ◽

Potential Measurement ◽

Laryngeal Paralysis ◽

Posterior Cricoarytenoid Muscle ◽

Lower Amplitude ◽

Vocal Fold Immobility ◽

Posterior Cricoarytenoid ◽

Thyroarytenoid Muscle

Objectives: We sought to determine the value of laryngeal electromyography (LEMG) and evoked LEMG in the diagnosis of vocal fold immobility. Methods: We analyzed 110 cases of vocal fold immobility by their clinical manifestations and LEMG characteristics, including spontaneous potential activity, motor unit potential measurement, recruitment pattern analysis, and evoked LEMG signals. Results: With LEMG, we identified 87 patients with neuropathic laryngeal injuries. Neurogenic vocal fold immobility showed a wide variety of abnormal activity. Fibrillation potentials and positive sharp waves were found in patients with laryngeal nerve injuries. For laryngeal paralysis, there was no reaction with LEMG and evoked LEMG. For incomplete laryngeal paralysis, decreased evoked LEMG signals were also seen with delayed latency (thyroarytenoid muscle, 2.2 ± 1.0 ms, p < 01; posterior cricoarytenoid muscle, 2.4 ± 1.0 ms, p < .05) and lower amplitude (thyroarytenoid muscle, 0.9 ± 0.7 mV, p < .05; posterior cricoarytenoid muscle, 1.2 ± 1.0 mV, p < .01). Nineteen patients with vocal fold mechanical limitations generally had normal LEMG and evoked LEMG signals. Four patients with neoplastic infiltration of the laryngeal muscles demonstrated abnormal LEMG signals but nearly normal evoked LEMG signals. Conclusions: We conclude that LEMG and evoked LEMG behavior plays a crucial role in the diagnosis of vocal fold immobility. The decreased recruitment activities on LEMG and the decreased evoked LEMG signals with longer latency and lower amplitude reflect the severity of neuropathic laryngeal injury.

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Semon's Law Revisited: An Electromyographic Analysis of Laryngeal Synkinesis

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610501002 ◽

1996 ◽

Vol 105 (10) ◽

pp. 764-769 ◽

Cited By ~ 107

Author(s):

Andrew Blitzer ◽

Anthony F. Jahn ◽

Anat Keidar

Keyword(s):

Electrical Activity ◽

Muscle Activity ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

Upright Position ◽

Laryngeal Electromyography ◽

Cricothyroid Muscle ◽

Abductor Paralysis ◽

Vocal Fold Immobility ◽

Electromyographic Analysis

Felix Semon's fascination with vocal fold paralysis led to his theory attributing medialization to isolated abductor paralysis. Later, the Wagner-Grossman hypothesis explained the vocal fold position on the basis of cricothyroid muscle activity. Other authors since that time have dispelled the notion of a role for the cricothyroid muscle in vocal fold position with paralysis. Utilizing laryngeal electromyography, several authors have found electrical activity suggestive of variable reinnervation and synkinesis. This current study included patients with persistent vocal fold immobility. Fourteen patients were studied: half with good voice and half with poor voice. The patients with good voice had a relatively normal arytenoid position and evidence of synkinesis. The group with poor voice had an arytenoid that tipped into the laryngeal inlet and had denervation or poor reinnervation. This suggests that the medialization and upright position of the arytenoid is due to synkinesis.

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