Recommendations of the Neurolaryngology Study Group on laryngeal electromyography

Abstract

The Neurolaryngology Study Group convened a multidisciplinary panel of experts in neuromuscular physiology, electromyography, physical medicine and rehabilitation, neurology, and laryngology to meet with interested members from the American Academy of Otolaryngology Head and Neck Surgery, the Neurolaryngology Subcommittee and the Neurolaryngology Study Group to address the use of laryngeal electromyography (LEMG) for electrodiagnosis of laryngeal disorders. The panel addressed the use of LEMG for: 1) diagnosis of vocal fold paresis, 2) best practice application of equipment and techniques for LEMG, 3) estimation of time of injury and prediction of recovery of neural injuries, 4) diagnosis of neuromuscular diseases of the laryngeal muscles, and, 5) differentiation between central nervous system and behaviorally based laryngeal disorders. The panel also addressed establishing standardized techniques and methods for future assessment of LEMG sensitivity, specificity and reliability for identification, assessment and prognosis of neurolaryngeal disorders. Previously an evidence-based review of the clinical utility of LEMG published in 2004 only found evidence supported that LEMG was possibly useful for guiding injections of botulinum toxin into the laryngeal muscles. An updated traditional/narrative literature review and expert opinions were used to direct discussion and format conclusions. In current clinical practice, LEMG is a qualitative and not a quantitative examination. Specific recommendations were made to standardize electrode types, muscles to be sampled, sampling techniques, and reporting requirements. Prospective studies are needed to determine the clinical utility of LEMG. Use of the standardized methods and reporting will support future studies correlating electro-diagnostic findings with voice and upper airway function.

Evaluation of Unilateral Vocal Fold Immobility

“…Similarly, a multidisciplinary panel convened by the Neurolaryngology Study Group of the American Academy of Otolaryngology-Head and Neck Surgery found that LEMG is most useful for predicting poor functional outcome and is clinically useful as a qualitative, rather than quantitative, measure. They concluded that further studies are needed to standardize the practice of LEMG and determine its optimum utility and clinical value [45].…”

Is laryngeal electromyography useful in the diagnosis and management of vocal fold paresis/paralysis?

“…1 LEMG performed in the proper time frame can provide prognostic information regarding recovery after vocal fold paralysis. Although the literature offers only level IV evidence, the data clearly indicate that LEMG can accurately predict (75%-100%) which patients will not recover vocal fold motion (Table 3 in Sataloff et al 1 and reference 57 in Blitzer et al 2 ). A recent study from Pittsburg 3 added evaluation for synkinesis to the traditional signs indicating a poor prognosis for recovery, which increased their LEMG predictive value for ''no return of movement'' from 80% to 100% at their institution.…”

“…1 Among otolaryngologists that have interest in laryngological disorders, up to three quarters use LEMG clinically. 2 Despite commonly accepted practice, in 2004, an evidence-based review was not able to support the use of LEMG by available published research. 1 The topic was re-evaluated in 2006 by the Neurolaryngology Study Group of the American Academy of Otolaryngology Head and Neck Surgery with the conclusion that there is a role for LEMG in the diagnosis of vocal fold movement disorders.…”

“…1 The topic was re-evaluated in 2006 by the Neurolaryngology Study Group of the American Academy of Otolaryngology Head and Neck Surgery with the conclusion that there is a role for LEMG in the diagnosis of vocal fold movement disorders. 2 …”

Role of Laryngeal Electromyography in Predicting Recovery After Vocal Fold Paralysis

“…Herein lies the role of Laryngeal electromyography (LEMG), a procedure for recording the electrophysiological phenomena occurring in the intrinsic laryngeal muscles using various types of electrodes [1][2][3][4].…”