Laryngeal Electromyography Findings Research Articles

Positive Predictive Value of Endoscopic Findings to Diagnose Vocal Fold Paresis.

Laryngoscopy corresponding with laryngeal electromyography (LEMG) is essential in diagnosing vocal fold paresis. However, baseline asymmetry or other diseases oftentimes confound the exam, making diagnosis difficult. There is currently no agreed upon endoscopic criteria proven to reliably correlate with LEMG findings. We define a set of endoscopic findings termed "paresis triad" that, when present together, reliably correlate with LEMG. The paresis triad consists of (1) hypocontraction of the weak side of the larynx with increased ventricular show, (2) hypercontraction of the intact side with bulging of the false fold covering the ventricle, and (3) tilting of the interarytenoid cleft to the weak side. We performed a retrospective review of patients with laryngeal asymmetry on laryngoscopy. Patients were divided into two groups: those with consistent paresis triad findings across all pitches and intensities, and those without. All patients underwent LEMG by a neurolaryngologist blinded to the laryngoscopic findings. The endoscopies were then rereviewed in a blinded manner by a second laryngologist to assess inter- and intrarater reliability for identification of the triad. Twelve patients met inclusion criteria (age 50 +/-15, 7F:5M). Nine had the paresis triad. Three had an inconsistent triad. All patients with the paresis triad had LEMG findings consistent with neurologic injury on the suspected side. All patients with inconsistent triad findings had normal LEMG. Our findings suggest the proposed laryngoscopic paresis triad may be useful objective criteria to diagnose paresis without the need for LEMG. Further prospective studies should examine a larger series of patients. 4 Laryngoscope, 133:1712-1716, 2023.

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

PurposeIn 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.MethodsBetween 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.ResultsLEMG 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).ConclusionOur 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.

Abnormal Laryngeal Electromyography Findings in Asymptomatic Adults Across the Age Spectrum.

Laryngeal electromyography (LEMG) is a diagnostic tool for patients with suspected neurogenic abnormalities of the larynx. LEMG is often used with the assumption that any abnormality is symptom-/disease-related. We sought to determine the prevalence of abnormal LEMG findings in a group of healthy asymptomatic adults across a large age spectrum. Open, prospective study, gender-match and age balanced by decade. Forty-six healthy participants (age 20-78) underwent LEMG, including 178 muscles. Participants had no history of voice problems, normal VHI-10, and normal flexible laryngoscopy. Qualitative and quantitative LEMG (bilateral) were performed involving the thyroarytenoid-lateral cricoarytenoid muscle complex (TA-LCA) and cricothyroid (CT) muscles. LEMG parameters included evaluation for fibrillation potentials, sharp waves, reduced recruitment, polyphasic potentials, electrical synkinesis, and measurement of turns per second. Of participants, 4% had at least one abnormal qualitative finding (slightly reduced recruitment or two to three discrete polyphasic potentials). There were no findings of fibrillation potentials or sharp waves. There were no abnormal qualitative findings in the CT muscles tested. Of participants, 16% had at least one abnormal synkinesis finding. LEMG qualitative abnormalities and quantitative abnormalities do not appear to correlate with gender or age. Abnormal qualitative and quantitative LEMG findings were uncommon and minor in severity in our group of asymptomatic healthy adults. The likelihood of abnormal LEMG results in asymptomatic adults was 2.2% for qualitative findings, 9.3% for synkinesis, and 5.4% for turns/s. 3 Laryngoscope, 131:2065-2069, 2021.

Laryngeal Electromyographic Findings in a Cohort of Recalcitrant Chronic Neurogenic Cough Patients

To evaluate the laryngeal electromyography findings of bilateral thyroarytenoid muscles in 10 patients with chronic, intractable coughing. This is a retrospective cohort case series. Clinical records were reviewed for demographic information, symptoms, and findings on bilateral laryngeal EMG for 10 patients referred for chronic coughing. All thyroarytenoid muscles tested demonstrated electromyographic evidence of neuropathy, with signs of denervation and reinnervation. There was reduced recruitment in all 20 thyroarytenoid muscles studied. In addition, polyphasic motor units were seen in all thyroarytenoid muscles, with increased amplitude in 18 of 20 thyroarytenoid muscles and increased duration in 17 of 20 thyroarytenoid muscles. Additionally, there was electromyographic evidence of synkinesis in 19 of 20 thyroarytenoid muscles studied, a sign of aberrant reinnervation. Patients with intractable coughing, despite numerous modalities of treatment, potentially have bilateral neuropathy of the recurrent laryngeal nerves suggesting the potential peripheral as well as central neuropathic changes as the etiology.

Prognosis of congenital idiopathic abductor laryngeal paralysis with laryngeal electromyography.

To assess if laryngeal electromyography could provide additional information in the prognosis of congenital bilateral idiopathic abductor vocal cord paralysis (abCBILP). We performed a retrospective review over a 23-year period (1995-2018) of all children younger than 13 years old in the Medical University of Innsbruck. We identified five infants with abCBILP. Fiberoptic laryngeal endoscopy revealed bilateral vocal cord immobility in adduction without accompanying laryngeal findings. Tracheostomy rate was 100%. Tracheostomy was performed after minimum 3 weeks of non-improvement with continuous positive airway pressure treatment or intubation. In all patients, repeated laryngeal electromyography revealed volitional activity. All patients showed excellent full late recovery in the second quinquennium of life. Presence of volitional activity in laryngeal electromyography could identify patients with excellent prognosis. Prospective laryngeal electromyography studies are required in more patients with abCBILP in order to document laryngeal electromyography findings also by patients with poor late recovery. Patients with poor prognosis could be selected for early laryngeal intervention to avoid tracheostomy-dependent issues. 4 Laryngoscope, 130:E252-E257, 2020.

Isolated Paresis of Laryngeal Adduction: What Are the Laryngoscopic and Stroboscopic Findings?

This study aimed to describe the videolaryngostroboscopic (VLS) findings in a cohort of patients with isolated paresis of laryngeal adduction and identify predictive variables that may be related to voice recovery. Chart review and VLS analysis of dysphonic patients diagnosed with isolated paresis of laryngeal adduction by laryngeal electromyography (LEMG). Demographic, clinical, VLS, and LEMG findings were analyzed according to the outcome of dysphonia. There were 17 patients, 12 males (70.6%), mean age of 46.6 years, with median dysphonia duration of 4 months (range, 1-60 months) included in the study. In all patients, gross movement of both vocal folds were normal. Laryngoscopy showed limited adduction of the ipsilateral ventricular fold, contralateral interarytenoid region deviation, and vocal fold atrophy in 100%, 94.1%, and 76.5% of patients, respectively. VLS findings included: impairment of glottic closure (94.1%), phase asymmetry (94.1%), and reduced mucosal wave on the affected side (76.5%). Predictors of good voice outcome were sudden onset (P = .012), duration of dysphonia on presentation shorter than 5 months (P = .005), and absence of polyphasic potentials on LEMG (P = .041). Findings on VLS as described suggest isolated paresis of laryngeal adduction and should warrant indication of LEMG for definite diagnosis. Voice improvement may be related to clinical and LEMG findings. 4 Laryngoscope, 129:919-925, 2019.

Effect of Levodopa + Carbidopa on the Laryngeal Electromyographic Pattern in Parkinson Disease

Vocal impairment is one of the main debilitating symptoms of Parkinson disease (PD). The effect of levodopa on vocal function remains unclear. This study aimed to determine the effect of levodopa on electromyographic patterns of the laryngeal muscle in patients with PD. This is a prospective interventional trial. Nineteen patients with PD-diagnosed by laryngeal electromyography-were enrolled. Cricothyroid and thyroarytenoid (TA) muscle activities were measured at rest and during muscle contraction (phonation), when participants were on and off medication (12 hours after the last levodopa dose). Prevalence of resting hypertonia in the cricothyroid muscle was similar in the off and on states (7 of 19, P = 1.00). Eight patients off medication and four patients on medication had hypertonic TA muscle at rest (P = 0.289). No electromyographic alterations were observed during phonation for either medication states. Despite a tendency for increased rest tracings in the TA muscle when participants were on medication, no association was found between laryngeal electromyography findings and levodopa + carbidopa administration.

Laryngeal Electromyographic findings in patients with vocal fold motion asymmetry.

Vocal fold motion asymmetry (VFMA) is often attributed to vocal fold paresis or an anatomical variant. Although laryngeal electromyography (LEMG) may be used to evaluate patients with vocal fold paresis, electrodiagnostic findings in VFMA have not been well defined. Review of a case series Twenty-five symptomatic patients with VFMA were examined by LEMG, and the findings were analyzed. Although all were thought to have unilateral recurrent laryngeal nerve paresis, LEMG showed only nine to have unilateral recurrent nerve paresis. There were nine with both ipsilateral recurrent laryngeal nerve and superior laryngeal nerve paresis, four with bilateral paresis, and three were normal. Reduced total number of units, reduced recruitment, motor units firing fast, and polyphasic units were more common, whereas fibrillation potentials, fasciculation, positive sharp waves, and complex repetitive discharges were uncommon. The LEMG findings are most consistent with old, healed neuropathy. McNemar's test for the acute versus chronic denervation potentials showed significant differences. VFMA has a high incidence of vocal fold paresis that can be better defined by LEMG. The site and side of paresis is often wrong based on laryngoscopy findings alone. The LEMG findings of VFMA appear to be consistent with old, healed neuropathy 4 Laryngoscope, 126:E273-E277, 2016.

Laryngeal myofascial pain syndrome as a new diagnostic entity of dysphonia.

To consider the feasibility of diagnosing intrinsic laryngeal muscle myofascial pain syndrome (MPS) in dysphonic patients who demonstrated immediate symptom and stroboscopic finding improvement after laryngeal electromyography (LEMG) without further treatment. A chart review of patients who showed subtle vocal fold movement abnormalities on a stroboscopic examination and underwent ultrasonography (US)-guided LEMG was performed. Patients with vocal fold paralysis, mucosal lesions, spasmodic dysphonia, and vocal tremor on stroboscopic examination were excluded. Among them, patients with normal EMG findings were included in this study. The patients who reported voice symptom improvement after LEMG without further treatment were placed in laryngeal MPS (LMPS) group and the other patients were placed in non-laryngeal MPS (non-MPS) group. Predisposing factors, voice symptom, symptom-duration, and stroboscopic findings of these patients were reviewed. Among the 16 patients, LEMG findings were normal, five (31%) were included in the LMPS group and the other 11 patients (69%) were included in the non-MPS group. All LMPS group patients had a history of voice abuse and reported odynophonia. The Korean Voice Handicap Index-10 score decreased significantly after US-guided LEMG without additional treatment in the LMPS group. The stroboscopic findings revealed that vocal fold hypomobility was the most common finding in the LMPS group, and two patients showed a muscle tension dysphonia pattern. The LMPS groups showed improvement of vocal fold mobility on 1-week stroboscopic evaluation. LMPS is a potential diagnosis for patients with vocal fold hypomobility finding on stroboscopic findings but with normal EMG results. Diagnosis of LMPS could be considered in patients who showed symptom and vocal fold movement improvement after LEMG.

Consensus statement: Using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis.

The purpose of this study was to develop an evidence-based consensus statement regarding use of laryngeal electromyography (LEMG) for diagnosis and treatment of vocal fold paralysis after recurrent laryngeal neuropathy (RLN). Two questions regarding LEMG were analyzed: (1) Does LEMG predict recovery in patients with acute unilateral or bilateral vocal fold paralysis? (2) Do LEMG findings change clinical management in these individuals? A systematic review was performed using American Academy of Neurology criteria for rating of diagnostic accuracy. Active voluntary motor unit potential recruitment and presence of polyphasic motor unit potentials within the first 6 months after lesion onset predicted recovery. Positive sharp waves and/or fibrillation potentials did not predict outcome. The presence of electrical synkinesis may decrease the likelihood of recovery, based on 1 published study. LEMG altered clinical management by changing the initial diagnosis from RLN in 48% of cases. Cricoarytenoid fixation and superior laryngeal neuropathy were the most common other diagnoses observed. If prognostic information is required in a patient with vocal fold paralysis that is more than 4 weeks and less than 6 months in duration, then LEMG should be performed. LEMG may be performed to clarify treatment decisions for vocal fold immobility that is presumed to be caused by RLN. Muscle Nerve 53: 850-855, 2016.

Recurrent laryngeal nerve recovery patterns assessed by serial electromyography.

Following acute injury to the recurrent laryngeal nerve (RLN), laryngeal electromyography (LEMG) is increasingly being used to determine prognosis for recovery. The LEMG findings change during the recovery process, but the timing of these changes is not well described. In this canine study, LEMGs were obtained serially following model RLN injuries. Animal Study. Thirty-six canine RLNs underwent crush (n = 6), complete transection with reanastomosis (n = 6), half-transection half-crush (n = 5), cautery (n = 5), stretch (n = 5), inferior crush (n = 4), or inferior transection with reanastomosis (n = 5) injuries. Injuries were performed 5 cm from cricoid or were 5 cm further inferior. Under light sedation, LEMG of thyroarytenoid muscles was performed monthly for 6 months following injury. At 6 months, spontaneous and induced vocal fold motion was assessed. Except for the stretch injury, the remaining groups showed very similar recovery patterns. Fibrillation potentials (FPs) and/or positive sharp waves (PSWs; signs of bad prognosis) were seen in all cases at 1 month and lasted on average for 2.26 months (range = 1-4 months). Motor unit potentials of at least 2+ (scale = 0-4+; signs of good prognosis) were seen beginning at 3.61 months (range = 2-6 months). The stretch injury was less severe, with 3 of 5 showing no FPs/PSWs at 1 month; all recovered full mobility. Ten of the 36 thyroarytenoid muscles (27.8%) had 1 electromyograph showing both bad prognosis and good prognosis signs simultaneously at 2 to 4 months postinjury. LEMG can be used to predict RNL recovery, but timing is important and LEMG results earlier than 3 months may overestimate a negative prognosis. NA Laryngoscope, 126:651-656, 2016.

Laryngeal Electromyography and Acoustic Voice Analysis in Parkinson's Disease: a comparative study

SummaryParkinson's disease (PD) involves a progressive depletion of dopamine in the basal ganglia leading to motor alterations. Oral communication impairment occurs in 75% to 90% of patients and has been poorly studied.Aimto asses laryngeal electromyography (LEMG) patterns and correlate them to vocal analysis in patients with Parkinson's disease.Materials and MethodsThis is a prospective study. Twenty six adults with PD underwent laryngeal electromyography. Rest and phonation potentials were analyzed. VOXMETRIA® and GRAM 5.1.6. ® were used in acoustic analysis.ResultsThe main electromyographic pattern observed in the PD group was rest hypertonicity meaning that patients with PD presented with spontaneous intrinsic laryngeal muscle activity during voice rest, which occurred in 73% of the individuals. Not a case of laryngeal tremor was detected by electromyography, although vocal tremor was detected by VOXMETRIA in 69.5% of the individuals and in 61% of them by perceptive-auditive analysis.ConclusionVocal tremor was the main acoustic change in the PD group, with no correlation to LEMG findings.

Laryngeal Electromyography: Are the Results Reproducible?

Laryngeal electromyography (LEMG) is an auxiliary diagnostic technique that is used to study neurologic diseases that affect the larynx. This study aimed to verify the reproducibility and accordance of LEMG findings obtained by different approaches applied to the same intrinsic laryngeal muscle in patients with neurologic disorders of the larynx. This study is prospective, blind, randomized, and controlled. Forty subjects (20 males and 20 females) aged between 21 and 78years underwent LEMG of the thyroarytenoid muscles by different techniques, with a total of 120 insertion sites for analysis. The electrophysiological findings were grouped as follows: (1) equal LEMG findings; (2) different LEMG findings but in agreement on the same electromyographic pattern; and (3) different LEMG findings and in discord on the same electromyographic pattern. We found 5% discordance in the LEMG findings between the sites analyzed. LEMG is an important and useful technique, but caution must be taken to avoid misinterpretation and the wrong muscle approach.

Laryngeal reinnervation featuring refined nerve-muscle pedicle implantation evaluated via electromyography and use of coronal images.

To evaluate the long-term efficacy of laryngeal reinnervation via refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction to treat unilateral vocal fold paralysis (UVFP), employing laryngeal electromyography (LEMG), coronal imaging, and phonatory function assessment. Case series with chart review. University hospital. We retrospectively reviewed 12 UVFP patients who underwent refined NMP implantation with arytenoid adduction. Videostroboscopy, phonatory functional analysis, LEMG, and coronal imaging were performed before and 2 years after surgery. In LEMG analysis, a 4-point scale was employed to grade motor unit (MU) recruitment: 4+ reflected no recruitment, 3+ greatly decreased recruitment, 2+ moderately decreased recruitment, and 1+ mildly decreased activity, associated with less than the full interference pattern. Coronal images were assessed in terms of differences in thickness and the vertical positions of the vocal folds. Phonatory function improved significantly after operation in all patients. In terms of LEMG findings, the preoperative MU recruitment scores were 1+ in no patients, 2+ in 4 patients, 3+ in 1 patient, and 4+ in 7 patients. Postoperative MU recruitment results were 1+ in 6 patients, 2+ in 5 patients, 3+ in 1 patient, and 4+ in no patients. Thinning of the affected fold during phonation was evident preoperatively in 9 of 10 patients. The affected and healthy folds were equal in volume in 4 of 9 patients postoperatively. The LEMG findings and coronal imaging suggest that NMP implantation may have enabled successful reinnervation of the laryngeal muscles of UVFP patients.

Laryngeal Reinnervation with Refined Nerve‐Muscle Pedicle Implantation Using Electromyography and Coronal Reconstructed Images

Objectives: Evaluate the long-term efficacy of laryngeal reinnervation with refined nerve-muscle pedicle (NMP) flap implantation combined with arytenoid adduction for unilateral vocal fold paralysis (UVFP) using laryngeal electromyography (LEMG), coronal images, and assessment of phonatory function. Methods: We retrospectively reviewed 16 UVFP patients who received refined NMP implantation with arytenoid adduction. Videostroboscopy, perceptual evaluation, acoustic analysis, aerodynamic analysis, LEMG, and coronal imaging were performed pre- and 2 years after surgery. For LEMG analysis, a four-point scale was employed to grade motor unit (MU) recruitment where 4+ represented absent recruitment, 3+ represented greatly decreased recruitment, 2+ represented moderately decreased recruitment, and 1+ represented mildly decreased activity with less than full interference pattern. Coronal images were assessed for differences in thickness of the vocal folds during phonation and inhalation. Results: Phonatory function results were significantly improved postoperatively for all patients. In LEMG findings, preoperative MU recruitment evaluation results were 1 patient for 1+, 5 for 2+, 1 for 3+, and 3 for 4+. Postoperative MU recruitment evaluation results were 7 patients for 1+, 3 for 2+, and none for 3+ and 4+. Thinning of the affected fold was evident during phonation in 15 of 16 patients preoperatively. The affected fold was at an equal volume with the healthy fold in 8 of 16 patients postoperatively. Conclusions: LEMG findings and coronal imagine demonstrates that refined NMP implantation results in successful reinnervation of laryngeal muscles in UVFP patients. Refined NMP implantation may provide near-normal voice function and restored laryngeal muscle tone and volume.

Laryngeal electromyography findings of vocal fold immobility in patients after radiotherapy for nasopharyngeal carcinoma

The clinical features of vocal fold immobility (VFI) after radiotherapy for nasopharyngeal carcinoma (NPC) have seldom been reported. We retrospectively reviewed laryngeal electromyography (LEMG) and tumor study findings to elucidate the common clinical features of patients who presented with VFI after radiotherapy for NPC. The LEMG signals obtained from the cricothyroid and thyroarytenoid muscles were used to confirm superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) injury. The medical records of 13 patients were reviewed and 11 of them had evidence of RLN injury. Six of the 11 patients also had SLN injury, indicating possible vagus nerve (VN) injury. Two patients had cricoarytenoid joint fixation without evidence of nerve injury. None of the nerve injuries were caused by skull base recurrence or tumor metastasis. VFI is usually caused by nerve injury, but it is not a malignant sign of tumor recurrence or metastasis.

Electromyography in Children's Laryngeal Mobility Disorders

To describe a consecutive series of children with laryngeal mobility disorders assessed by laryngeal electromyography (LEMG), to propose a grading system for LEMG findings, and to determine whether the LEMG grades correlate with requirement for tracheostomy. Retrospective, observational, uncontrolled study. A single pediatric otolaryngology practice. Children who had LEMG performed and a minimum follow-up of 3 months. Demographic characteristics, diagnoses, surgical procedures, number of LEMG procedures, and complications were obtained. The LEMG results from the thyroarytenoid and posterior cricoarytenoid muscles were graded 0 to 4 according to amplitude and relation to the phase of respiration. A correlation analysis between the need for tracheostomy and the baseline LEMG score as well as a multivariable analysis to determine the predictors of requirement for tracheostomy were performed. Between April 28, 2008, and November 2, 2011, 43 LEMG procedures were performed on 23 patients (13 girls; mean [SD] age, 1.5 [2.85] years). Eight required tracheostomy. Among the 23 patients, 16 had laryngeal paralysis (11 bilateral, 5 unilateral), 4 had laryngeal dyskinesia, and 3 had miscellaneous conditions. Fourteen had secondary large airway lesions, and 14 had a nonairway diagnosis that affected respiration. The overall LEMG results correlated negatively with requirement for tracheostomy (r = -0.4; P < .05) and were 86.36% accurate compared with endoscopy. No predictors for tracheostomy were identified. The LEMG grading was accurate and correlated with the requirement for tracheostomy. Combined with endoscopy, the grading may help better characterize laryngeal mobility disorders.

Laryngeal EMG for Unilateral Vocal Fold Paralysis

Objective: 1) Examine the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of using laryngeal electromyography (LEMG) to predict the prognosis of unilateral vocal fold paralysis (UVFP). 2) Provide better evidence support for using LEMG to predict the prognosis of UVFP via a prospective long-term study. Method: Sixty-six patients with UVFP were prospectively collected from 2007 to 2011. LEMG findings were dichotomized to negative (good prognosis) or positive (poor prognosis). The motions of paralyzed vocal folds were followed by videolaryngoscopy at least 3 months after LEMG. and the association with LEMG findings were analyzed. Results: The mean duration of LEMG after symptoms onset and follow up after LEMG were 3.4 months and 12 months, respectively. Fifty-seven patients had positive findings (less than 80% of normal motor unit recruitment or presence of fibrillations) in LEMG and 55 patients remained UVFP in the follow-up. Nine patients had negative findings (80%-100% motor unit recruitment) in LEMG and 3 patients recovered vocal fold motion. LEMG findings are significantly associated with the outcome of UVFP ( P = .016; Fisher’s exact test). The accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 87.9%, 90.2%, 60%, 96.5%, and 33.3%, respectively. Conclusion: This study confirms that LEMG can reliably offer prognostic information for UVFP. Especially for patients with positive finding of LEMG, the chance of recovery of vocal fold motion will be very low.

Intraoperative Laryngeal Electromyography in Children With Vocal Fold Immobility&lt;subtitle&gt;Results of a Multicenter Longitudinal Study&lt;/subtitle&gt;

To determine whether laryngeal electromyography (LEMG) can predict recurrent laryngeal nerve function return in children and whether LEMG can aid in the management of vocal fold immobility (VFI). Prospective case series. Tertiary pediatric aerodigestive centers. Twenty-five children aged 14 days to 7 years at the time of first LEMG (mean age, 21.4 months) with VFI who underwent flexible fiberoptic laryngeal examination, intraoperative LEMG of the thyroarytenoid muscles, and 12-month follow-up. To compare results of LEMG with flexible fiberoptic laryngeal examination in children with vocal fold paresis and to determine if LEMG can predict vocal fold return. In children who had a patent ductus arteriosus ligation, the LEMG data suggest that if there is no activity 6 months after injury, then the nerve is unlikely to regain function. In 3 of 3 children with central causes of VFI, normal LEMG findings predicted return of nerve function 2 to 7 months before vocal fold movement on fiberoptic examination. Finally, in 3 of 3 children with idiopathic VFI, LEMG predicted return within 2 to 14 months of vocal folds with normal findings. Intraoperative LEMG is a safe, easy-to-use method for determining the likelihood of recurrent laryngeal nerve function return in children who have undergone patent ductus arteriosus ligation, in children with centrally correctable lesions, and in children with idiopathic VFI. More work is needed in the area of pediatric LEMG, but it is possible that LEMG data can be used to aid in management strategies and provide families with more information to make better informed decisions regarding their child's care.

Evaluation of Dysphagia After Cervical Surgery Using Laryngeal Electromyography

The purpose of this study was to investigate the causes of dysphagia after cervical surgery using laryngeal electromyography (LEMG), and the effect of laryngeal neuropathy on the severity of dysphagia. Seventeen patients with dysphagia evident after cervical surgery were included. Video fluoroscopic swallow study (VFSS) parameters evaluated included the volume of residue in the vallecular pouch and the pyriform sinus, the Rosenbek penetration-aspiration scale (PAS), and the swallowing function scoring system (SFSS). By VFSS findings, patients were classified into a mild or severe dysphagia group. Nine of 17 patients showed voice change. SFSS scores were 0 in 2 patients, 3 in 1 patient, 4 in 1 patient, 5 in 1 patient, and 6 in 12 patients. PAS scores were 1 in 8 patients, 2 in 5 patients, 7 in 3 patients, and 8 in 1 patient. Laryngeal neuropathy was evident in seven patients (41.2%). Of these, all patients exhibited recurrent laryngeal neuropathy and 28.6% had superior laryngeal neuropathy. When we evaluated LEMG findings with respect to the severity of dysphagia, the severe dysphagia group showed significant association with the presence of laryngeal neuropathy (p=0.006). Although the level of residue in the vallecular pouch was not associated with the presence of laryngeal neuropathy (p=0.442), the amount of residue in the pyriform sinus did show a significant association (p=0.020).