Laryngeal Electromyography for Prognosis of Vocal Fold Paralysis.

This study aimed to determine the value of laryngeal electromyography in the prognosis of vocal fold paralysis. This is a retrospective descriptive study. This study included 80 patients diagnosed with unilateral or bilateral vocal fold paralysis on flexible laryngoscopy between 2002 and 2014 in a tertiary medical center. Laryngeal electromyography using a standardized protocol was performed; the outcome measures were classified and analyzed into two groups according to the degree of injury. Group 1 included patients with mild to moderate injury, and group 2 included patients with severe to complete injury. Prognosis was correlated with vocal fold motion recovery status with a minimum of 6 months of follow-up since the symptoms onset using positive and negative predictive values. Sixty patients showed acute or chronic recurrent laryngeal neuropathy in laryngeal electromyography. Twelve of 41 patients included in group 1 recovered motion, and 30 of 35 patients included in group 2 did not recover, resulting in 88.2% of positive predictive value and 35.7% of negative predictive value. Our data confirm that laryngeal electromyography is a useful clinical tool in predicting poor recovery in patients with vocal fold paralysis. It allows identification of candidates for early intervention.

Pardo-Maza A ，García-Lopez I ，Santiago-Pérez S ，Gavilán J ... -  《-》

Vocal fold motion outcome based on excellent prognosis with laryngeal electromyography.

As laryngeal electromyography (LEMG) becomes more refined, accurate predictions of vocal fold motion recovery are possible. Focus has been on outcomes for patients with poor prognosis for vocal fold motion recovery. Limited information is available regarding the expected rate of purposeful vocal fold motion recovery when there is good to normal motor recruitment, no signs of denervation, and no signs of synkinetic activity with LEMG, termed excellent prognosis. The objective of this study is to determine the rate of vocal fold motion recovery with excellent prognosis findings on LEMG after acute recurrent laryngeal nerve injury. Retrospective review. Patients undergoing a standardized LEMG protocol, consisting of qualitative (evaluation of motor recruitment, motor unit configuration, detection of fibrillations, presence of synkinesis) and quantitative (turns analysis) measurements were evaluated for purposeful vocal-fold motion recovery, calculated after at least 6 months since onset of injury. Twenty-three patients who underwent LEMG for acute vocal fold paralysis met the inclusion criteria of excellent prognosis. Eighteen patients (78.3%) recovered vocal fold motion, as determined by flexible laryngoscopy. Nearly 80% of patients determined to have excellent prognosis for vocal fold motion recovery experienced return of vocal fold motion. This information will help clinicians not only counsel their patients on expectations but will also help guide treatment. 4. Laryngoscope, 126:2310-2314, 2016.

Smith LJ ，Rosen CA ，Munin MC 《-》

Utility of laryngeal electromyography in predicting recovery after vocal fold paralysis.

Munin MC ，Rosen CA ，Zullo T 《ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION》

Relationship Between Laryngeal Electromyography and Video Laryngostroboscopy in Vocal Fold Paralysis.

The objective of this study was to better define the relationship of laryngeal electromyography and video laryngostroboscopy in the diagnosis of vocal fold paralysis. Retrospective diagnostic cohort study with cross-sectional data analysis METHODS: Data were obtained from 57 patients with unilateral vocal fold paralysis who attended a large tertiary voice referral center. Electromyographic findings were classified according to recurrent laryngeal nerve, superior laryngeal nerve, and high vagal/combined lesions. Video laryngostroboscopy recordings were classified according to the position of the immobile fold into median, paramedian, lateral, and a foreshortened/hooded vocal fold. The position of the paralyzed vocal fold was then analyzed according to the lesion as determined by electromyography. The recurrent laryngeal nerve was affected in the majority of cases with left-sided lesions more common than right. Vocal fold position differed between recurrent laryngeal and combined vagal lesions. Recurrent laryngeal nerve lesions were more commonly associated with a laterally displaced immobile fold. No fold position was suggestive of a combined vagal lesion. The inter-rater reliability for determining fold position was high. Laryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. Such findings indicate that further unknown mechanisms contribute to fold position in unilateral paralysis.

Maamary JA ，Cole I ，Darveniza P ，Pemberton C ，Brake HM ，Tisch S ... -  《-》

Laryngeal electromyography and prognosis of unilateral vocal fold paralysis--a long-term prospective study.

To confirm the value of using laryngeal electromyography (LEMG) to predict the long-term prognosis of unilateral vocal fold paralysis (UVFP), and elucidate the adequate timing of LEMG. Prospective cohort prognosis study. The LEMG data of 84 patients with UVFP were prospectively collected, and 81 patients received follow-up at least 6 months after symptom onset. If the paralyzed vocal fold had <20% recruitment reduction during phonation compared to the normal vocal fold signals, and absence of fibrillation when the patient was silent, the prognosis was considered to be good (negative finding). Otherwise, the prognosis was considered to be poor (positive finding). The association between UVFP outcome and LEMG prognostic rules and the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of LEMG were calculated. The mean duration of LEMG after symptom onset was 3.7 months, and follow-up after symptoms onset was 18.4 months. Sixty-six of 71 patients with a positive finding had persistent UVFP; four of 10 patients with a negative finding recovered vocal fold motion. LEMG results were significantly associated with the outcome of UVFP (P = .007). The overall accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 86.4%, 91.7%, 44.4%, 93.0%, and 40.0%, respectively. When LEMG was done more than 2 months after symptom onset, the PPV was 97.9%. LEMG has a high PPV in predicting the long-term outcome of UVFP patients with poor prognosis. Permanent laryngeal framework surgery is feasible if patients have positive findings at least 2 months after symptom onset.

Wang CC ，Chang MH ，De Virgilio A ，Jiang RS ，Lai HC ，Wang CP ，Wu SH ，Liu SA ... -  《-》