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Invited Review: Utility of laryngeal EMG for establishing prognosis and individualized treatment after laryngeal neuropathies
Invited Review: Utility of laryngeal EMG for establishing prognosis and individualized treatment after laryngeal neuropathies
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Abstract

Laryngeal electromyography (LEMG) is a technique used to characterize neuropathic injuries to the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN). The RLN and SLN innervate the laryngeal muscles to produce vocal fold (VF) motion and elongation, respectively. VF motion deficiencies can affect voice, swallowing, and breathing, which can greatly affect a patient's quality of life. Neuropathy-related VF motion deficiencies most often result from surgical interventions to the skull base, neck, or chest likely due to the circuitous route of the RLN. LEMG is ideally conducted by an electromyographer and an otolaryngologist using a team-approach. LEMG is a powerful diagnostic tool to better characterize the extent of neuropathic injury and thus clarify the prognosis for VF motion recovery. This updated review discusses current techniques to improve the positive and negative predictive values of LEMG using laryngeal synkinesis and quantitative LEMG. Synkinesis can be diagnosed by comparing motor unit potential amplitude during vocalization and sniff maneuvers when recording within adductor muscles. Quantitative turns analysis can measure motor unit recruitment to avoid subjective descriptions of reduced depolarization during vocalization, and normal values are >400 turns/s. By integrating qualitative, quantitative, and synkinetic data, a robust prognosis can help clinicians determine if VF weakness will recover. Based on LEMG interpretation, patient-centered treatment can be developed to include watchful waiting, temporary VF augmentation, or definitive medialization procedures and laryngeal reinnervation.

Objectives: The objectives of this activity are to: 1) Understand laryngeal anatomy, innervation, and the etiologies of lesions to the recurrent and superior laryngeal nerves so as to be able to properly assess patients presenting with possible injuries to these nerves; 2)Understand and apply the principles for proper performance and interpretation of laryngeal EMG; 3)Use laryngeal EMG to determine prognosis for recovery of vocal fold motion. 


ACCREDITATION STATEMENT
The AANEM is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.


CREDIT DESIGNATION
The AANEM is accredited by the American Council for Continuing Medical Education (ACCME) to providing continuing education for physicians. AANEM designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

DISCLOSURE INFORMATION
Both Drs. Smith and Munin contributed equally to the writing and editing of this manuscript. Dr Smith is on the advisory board for Inovio Pharmaceuticals but no conflicts with this review. Dr Munin declares research support from Abbvie, Merz and Ipsen and consulting with Pacira but no conflicts with this review. We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.


FORMAT
PDF
Authors
Libby J. Smith, D.O. and Michael C. Munin, M.D.
Summary
Availability: On-Demand
Expires on Jul 29, 2027
Cost: Member: $0.00
Non-Member: $25.00
Credit Offered:
1 CME Credit
1 CEU Credit


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