A proposal to extend application of laryngeal electromyography (LEMG)-guided vocal fold injection to treatment of unilateral vocal fold paralysis to enhance clinical popularity of LEMG: response to the paper by G.F. Volk et al.

Abstract

As faithful readers of the European Archives of Otorhinolaryngology, we read with great interest the article entitled ‘‘Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society’’ by Volk et al. [1]. We would like to compliment the authors and the members of the European Laryngological Society for proposing practical guidelines for laryngeal electromyography (LEMG). The equipment, monitoring, documentation, and interpretation of LEMG for vocal fold immobility were comprehensively reviewed in this paper and we believe this article will be an important reference for both beginners and experts. However, as the authors mentioned, many laryngologists do not routinely use LEMG even though it has been considered as a valuable diagnostic tool for more than 60 years. It is clear that further discussion and innovations will be needed to enhance the clinical popularity of LEMG. Here, we would like to share our ideas about using LEMG-guided vocal fold injection for unilateral vocal fold paralysis (VFP) and also propose this procedure as an innovative implementation of LEMG. According to the review by Sataloff et al. [2], LEMG has been used for diagnosis, prognosis, and treatment of laryngeal movement disorders. The two most common movement disorders in which LEMG can be applied are VFP and spasmodic dysphonia (SD). However, in their review, the authors revealed that LEMG has been used to treat SD but not VFP. Since Ludlow et al. [3] successfully used LEMG to guide botulinum toxin injection for adductor SD, injecting botulinum toxin through the cricothyroid membrane submucosally at the thyroarytenoid muscle using LEMG guidance has become the most popular treatment modality for SD [4]. Conversely, although the TA muscle is also the target of vocal fold injection augmentation for unilateral VFP, no LEMG-guided injection augmentation has ever been reported. In our experience, the accuracy of LEMG in predicting the prognosis of unilateral VFP was as high as 87 % [5]. But regardless of the result of an LEMG test, patients still need treatment for their symptoms. If we could perform vocal fold injection augmentation via an injectable needle electrode during LEMG, prognosis, evaluation, and treatment could be achieved in one step (Figs. 1, 2, video). Therefore, we propose an algorithm for adopting this Electronic supplementary material The online version of this article (doi:10.1007/s00405-012-2211-4) contains supplementary material, which is available to authorized users.