2024 Workshop Handout Bundle-W08A EMG Laryngeal- Munin

W08A EMG Laryngeal- Munin

Pdf Summary

The invited review by Libby J. Smith and Michael C. Munin discusses the utility of laryngeal electromyography (LEMG) in diagnosing laryngeal neuropathies, which impact vocal fold (VF) motion. LEMG is particularly useful after recurrent laryngeal nerve (RLN) injuries, frequently caused by surgeries involving the skull base, neck, or chest. This diagnostic tool helps establish prognosis for VF motion recovery and inform individualized treatment plans, including watchful waiting, VF augmentation, or surgical interventions.<br /><br />The recurrent and superior laryngeal nerves play crucial roles in VF movement, affecting voice, swallowing, and breathing. Damage to these nerves can result in VF paralysis or paresis. LEMG, conducted by an electromyographer and an otolaryngologist, allows clinicians to assess the severity and nature of the nerve damage and predict recovery.<br /><br />The review emphasizes the importance of understanding laryngeal anatomy and nerve pathways in interpreting LEMG results, with particular focus on the phenomena of laryngeal synkinesis—misdirected nerve regrowth following injury—which can affect prognosis. The authors suggest that LEMG findings, when interpreted together with other clinical methods like laryngoscopy, can significantly improve prognostic accuracy.<br /><br />LEMG should be conducted at specific times after injury for optimal prognosis, ideally between 2 and 6 months post-diagnosis, to assess the potential for VF motion recovery. Quantitative turns analysis can offer objective data, measuring motor unit recruitment during tasks like phonation and sniffing.<br /><br />Moreover, the review highlights LEMG's role in choosing treatment strategies, ranging from temporary VF augmentation to definitive surgical procedures, and discusses its potential in bilateral VF paralysis and laryngeal reinnervation. Pain and discomfort during the procedure are noted, but the impacts are generally manageable and outweighed by the clinical benefits. The article concludes by emphasizing the role of LEMG in guiding tailored treatment strategies to improve patient quality of life.

Keywords

laryngeal electromyography

laryngeal neuropathies

vocal fold motion

recurrent laryngeal nerve

laryngeal synkinesis

vocal fold paralysis

laryngoscopy

laryngeal anatomy

treatment strategies

laryngeal reinnervation