Value of Laryngeal Electromyography in Diagnosis of Vocal Fold Immobility

2007 ◽  
Vol 116 (8) ◽  
pp. 576-581 ◽  
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.

Study on Normal Laryngeal Electromyography of Thyroarytenoid Muscle, Cricothyroid Muscle, and Posterior Cricoarytenoid Muscle

2018 ◽  
Vol 127 (11) ◽  
pp. 806-811
Author(s):  
Xinlin Xu ◽  
Pan Yang ◽  
Peiyun Zhuang ◽  
Jiao Yanchao ◽  
Ma Yanli ◽  
...  
Keyword(s):  
Motor Unit ◽  
Physiological Activity ◽  
Motor Unit Potential ◽  
Deep Inspiration ◽  
Laryngeal Electromyography ◽  
Cricothyroid Muscle ◽  
Posterior Cricoarytenoid Muscle ◽  
Intrinsic Laryngeal Muscle ◽  
Posterior Cricoarytenoid ◽  
Thyroarytenoid Muscle

Objective: The aim of this study was to investigate the physiological activity of intrinsic laryngeal muscle under different functional states of larynx by measuring the normal laryngeal electromyography parameters. Methods: Laryngeal electromyography (EMG) was performed in 112 patients with unilateral vocal cord movement disorder. The duration and amplitude of the motor unit potential (MUP) of the thyroarytenoid muscle (TA), posterior cricoarytenoid muscle (PCA), and cricothyroid muscle (CT) were measured when patients were asked to make a deep inspiration and phonate /i/. The normal side of the patients’ vocal chords was used as the research object. Results: (1) The motor unit potential of TA, CT, and PCA were measured when inspiration and phonating /i/. Waveforms were normal. (2) There were significant differences in duration of TA between inspiration and phonating /i/ in comfortable tone. (3) When comparing the duration and amplitude of any 2 of TA, CT, and PCA during inspiration and phonating /i/, there were significant differences in duration between CT and PCA when phonating /i/ only. There were no significant differences in any other comparisons. Conclusions: Under either deep inspiration or pronunciation, the TA, CT, and PCA muscles were activated. The TA may play a major role in phonating. The PCA may play a major role in the action of deep inspiration.

Intraoperative Laryngeal Electromyographic Assessment of Patients with Immobile Vocal Fold

1992 ◽  
Vol 101 (10) ◽  
pp. 799-806 ◽  
Author(s):  
Peak Woo ◽  
Hernando Arandia
Keyword(s):  
Vocal Fold ◽  
Muscle Relaxation ◽  
Motor Units ◽  
Vocal Folds ◽  
Electrode Position ◽  
Recurrent Nerve ◽  
Laryngeal Paralysis ◽  
Vocal Fold Immobility ◽  
Hook Wire ◽  
Thyroarytenoid Muscle

The differential diagnosis of laryngeal ankylosis versus paralysis is occasionally difficult in patients with immobile vocal folds. Eight patients with acute and chronic evidence of vocal fold immobility were investigated by intraoperative electromyography (IEMG) during planned microlaryngoscopy. Bipolar hook wire electrodes were inserted into the thyroarytenoid muscle, of which the electrical activity was monitored during neuromotor blockade and emergence from anesthesia. The normal side and the side with ankylosis or stenosis showed normal IEMG activity. There was progressive recruitment of larger motor units during recovery from muscle relaxation. Patients with laryngeal paralysis failed to show such recruitment patterns. Thus, IEMG can be used as a diagnostic tool during operative laryngoscopy to differentiate neuromotor injury from anatomic causes of vocal fold immobility. The advantages of IEMG are its ease of application and certainty of electrode position. It can also be used to monitor recurrent nerve integrity and detect early laryngospasm. Further IEMG clinical study is warranted.

Laryngeal Electromyography for Adult Unilateral Vocal Fold Immobility: A Survey of the American Broncho-Esophagological Association

2005 ◽  
Vol 114 (6) ◽  
pp. 425-428 ◽  
Author(s):  
Stacey L. Halum ◽  
Nalin Patel ◽  
Timothy L. Smith ◽  
Safwan Jaradeh ◽  
Robert J. Toohill ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Management Strategies ◽  
Clinical Information ◽  
Laryngeal Electromyography ◽  
Bipolar Electrodes ◽  
Attitudes And Practices ◽  
Significant Difference ◽  
Survey Results ◽  
Vocal Fold Immobility ◽  
Posterior Cricoarytenoid

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.

scholarly journals Unilateral and Bilateral Laryngeal Pacing for Bilateral Vocal Fold Paralysis

2020 ◽  
Vol 8 (4) ◽  
pp. 395-401
Author(s):  
Maria E. Powell ◽  
David L. Zealear ◽  
Yike Li ◽  
C. Gaelyn Garrett ◽  
Kate Von Wahlde ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Minimally Invasive ◽  
Vocal Fold ◽  
Vocal Fold Paralysis ◽  
Strenuous Exercise ◽  
Advantages And Disadvantages ◽  
Bilateral Vocal Fold Paralysis ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid ◽  
Better Than

Abstract Purpose of Review Present the state-of-the-art overview of laryngeal pacing for treatment of bilateral vocal fold paralysis. A minimally invasive unilateral pacing system and a fully implantable bilateral pacing system are currently in clinical trials. The relative advantages and disadvantages of each are discussed. Recent Findings Research in functional electrical stimulation for the reanimation of the posterior cricoarytenoid muscle has successfully translated from animal models to human clinical trials for unilateral pacing and bilateral pacing. Current findings suggest unilateral pacing in humans significantly improves ventilation but only marginally better than cordotomy. Bilateral pacing in canines increases glottal opening greater than 2-fold over unilateral pacing and restores exercise tolerance to normal. Summary Unilateral pacing can be considered a breathing assist device and may not be appropriate for active individuals. Bilateral pacing may be preferable for patients who wish to engage in strenuous exercise. Minimally invasive systems may be ideal for patients who prefer less invasive implantation and are not concerned with cosmesis. Fully implantable pacing systems offer greater electrode redundancy and stability, resulting in a system that is robust against electrode migration or damage.

Electrically Stimulated Pacing of the Posterior Cricoarytenoid Muscle with Inspiration in Patients with Laryngeal Paralysis

1995 ◽  
Vol 113 (2) ◽  
pp. P117-P117
Author(s):  
David L. Zealear ◽  
Cheryl L. Rainey ◽  
Garrett D. Herzon ◽  
James L. Netterville ◽  
Robert H. Ossoff D.
Keyword(s):  
Laryngeal Paralysis ◽  
Posterior Cricoarytenoid Muscle ◽  
Posterior Cricoarytenoid

Electrical Pacing of the Paralyzed Human Larynx

1996 ◽  
Vol 105 (9) ◽  
pp. 689-693 ◽  
Author(s):  
Cheryl L. Rainey ◽  
Garrett D. Herzon ◽  
David L. Zealear ◽  
James L. Netterville ◽  
Robert H. Ossoff
Keyword(s):  
Electrical Stimulation ◽  
Vocal Fold ◽  
Abductor Muscle ◽  
Spontaneous Movement ◽  
Normal Side ◽  
Posterior Cricoarytenoid Muscle ◽  
Human Larynx ◽  
Posterior Cricoarytenoid ◽  
Electrical Pacing ◽  
Stimulation Of

This study represents the first attempt to electrically pace the paralyzed human larynx. The goal was to determine if electrical stimulation of the posterior cricoarytenoid muscle could produce functional abduction of the vocal fold in pace with inspiration. An external apparatus was used to sense inspiration and reanimate the unilaterally paralyzed larynx of a thyroplasty patient. Stimuli were delivered through a needle electrode to locate and pace the abductor muscle. The magnitude of electrically induced abduction was comparable to spontaneous movement on the normal side. The abduction was appropriately timed with inspiration; this finding demonstrated that this simple pacing system could effectively modulate stimulation with patient respiration.

Timing of Glottic Closure during Swallowing: A Combined Electromyographic and Endoscopic Analysis

2005 ◽  
Vol 114 (6) ◽  
pp. 478-487 ◽  
Author(s):  
Douglas J. Van Daele ◽  
Timothy M. McCulloch ◽  
Phyllis M. Palmer ◽  
Susan E. Langmore
Keyword(s):  
Human Subjects ◽  
Case Series ◽  
Video Frame ◽  
Electromyographic Activity ◽  
Healthy Human ◽  
Glottic Closure ◽  
Posterior Cricoarytenoid Muscle ◽  
Multiple Trials ◽  
Posterior Cricoarytenoid ◽  
Thyroarytenoid Muscle

Objectives: We performed a case series to enhance our understanding of the coupling between neuromuscular events and glottic closure. Methods: We performed combined flexible video laryngoscopy and electromyography in 4 healthy human subjects. Hooked-wire electrodes were placed in the superior pharyngeal constrictor, longitudinal pharyngeal, cricopharyngeus, thyroarytenoid, genioglossus, suprahyoid, and posterior cricoarytenoid muscles. A flexible endoscope tip was positioned in the oropharyngeal-hypopharyngeal region. The subjects performed multiple trials each of 10-mL normal and super-supraglottic liquid swallows. Results: Arytenoid movement consistently preceded full glottic closure and was associated with cessation of activity of the posterior cricoarytenoid muscle. In 89% of normal swallows, the glottis was partially open in the video frame before bolus passage. The maximum amount of thyroarytenoid electromyographic activity occurred during endoscopic white-out. When subjects executed a super-supraglottic swallow, early thyroarytenoid activity coincided with arytenoid contact. Conclusions: The initial medialization of the arytenoids is due to a decrease in motor tone of the posterior cricoarytenoid muscle. Full glottic closure typically occurs late in the process of swallowing, with activation of the thyroarytenoid muscle. Shifting of arytenoid medialization and glottic closure earlier in the super-supraglottic swallow indicates that glottic closure is under significant voluntary control.

scholarly journals Suppression of Thyroarytenoid Muscle Responses during Repeated Air Pressure Stimulation of the Laryngeal Mucosa in Awake Humans

2005 ◽  
Vol 114 (4) ◽  
pp. 264-270 ◽  
Author(s):  
Pamela Reed Kearney ◽  
Eric A. Mann ◽  
Christopher J. Poletto ◽  
Christy L. Ludlow
Keyword(s):  
Air Pressure ◽  
Repeated Presentation ◽  
Repeated Stimulation ◽  
Laryngeal Mucosa ◽  
Posterior Cricoarytenoid Muscle ◽  
Interstimulus Intervals ◽  
Posterior Cricoarytenoid ◽  
Muscle Responses ◽  
Thyroarytenoid Muscle ◽  
Stimulation Of

Repeated stimulation of the laryngeal mucosa occurs during speech. Single stimuli, however, can elicit the laryngeal adductor response (LAR). Our hypothesis was that the LAR to repeated rapid air pressure stimuli is centrally suppressed in humans. Hookedwire electrodes were inserted into the thyroarytenoid and cricothyroid muscles on both sides and into the posterior cricoarytenoid muscle on one side. Pairs of air puff stimuli were presented to the mucosa over the arytenoids at pressure levels three times threshold with interstimulus intervals from 250 to 5,000 ms. Bilateral thyroarytenoid responses occurred at around 150 ms to more than 70% of the initial stimuli. With repeated presentation at intervals of 2 seconds or less, the percent occurrence decreased to less than 40% and response amplitudes were reduced by 50%. Central suppression of adductor responses to repeated air puff stimuli may allow speakers to produce voice without eliciting reflexive spasms that could disrupt speech.

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