Laryngeal Electromyography: Present and Future
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NEUROLARYNGOLOGY (AJ MCWHORTER AND L ADKINS, SECTION EDITORS)
Laryngeal Electromyography: Present and Future R. Jun Lin 1
&
Lawrence R. Robinson 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Laryngeal electromyography (LEMG) is considered an essential diagnostic tool in laryngology but has not been widely utilized. The objective of this review is to present recent advances in LEMG. Recent Findings The addition of quantitative analysis and adductor synkinesis testing to the traditional qualitative analysis has improved the accuracy of LEMG and provide opportunities for future research. Summary Establishing a team as well as having a standardized testing and reporting protocol will contribute greatly to the clinical value and research utility of LEMG. Keywords Laryngeal electromyography . LEMG . Vocal fold paralysis . Review
Introduction Laryngeal electromyography (LEMG) is a diagnostic tool to confirm recurrent laryngeal nerve (RLN) injury and to determine the prognosis of spontaneous vocal fold motion recovery in patients with vocal fold paralysis (VFP). Although LEMG is considered an essential component in laryngeal assessment, it has not been commonly utilized clinically due to a lack of agreement on its methodology, interpretation, validity, and clinical application [1,2]. A survey conducted amongst laryngologists in the USA showed that only 21% performed LEMG on over 50% of VFP patients [3]. The same survey was conducted to its members by the European Laryngological Society (ELS), which showed that 28% of laryngologists regularly used This article is part of the Topical collection on Neurolaryngology * R. Jun Lin [email protected] Lawrence R. Robinson [email protected] 1
Department of Otolaryngology - Head & Neck Surgery, Laryngology, St. Michael’s Hospital & Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
2
Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
LEMG [4•]. Those who use LEMG typically work in university hospitals and in departments with higher volumes of VFP patients per month [4•]. A diagnostic LEMG can confirm RLN neuropathy. It can also prognosticate spontaneous vocal fold motion recovery following RLN injury. An evidence-based consensus statement published by the American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) reported that active voluntary motor unit potential (MUP) recruitment and the presence of polyphasic MUPs on LEMG within the first 6 months after RLN injury predict recovery of vocal fold motion [5•]. The addition of quantitative LEMG analysis to qualitative analysis of motor unit recruitment and morphology allows patient categorization into excellent, fair, and poor prognosis of vocal fold motion recovery [6]. Further, the presence of adductor synkinesis on LEMG will downgrade a patient’s prognosis for vocal fold motion recovery to the poor cate
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