Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

Dahle, Geir; Setså, Erling Johan; Svendsen, Øyvind; Stangeland, Lodve; Heimdal, John‐Helge; Henriksen, Bård; Husby, Paul; Brauckhoff, Katrin

doi:10.1002/lary.28215

Cited by 6 publications

(10 citation statements)

References 26 publications

(56 reference statements)

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“…Nerve integrity is guaranteed, if normal EMG‐amplitude is measured by IONM. EMG amplitude seems compellingly to reflect vocal cord contractility, at least during RLN traction stress, as recently demonstrated in animal experiments comparing EMG with vocal cord accelerometry 18 . However, in clinical practice the reported accuracy of IONM for predicting VCP early after surgery is highly variable with PPVs ranging from 12% to 88% 5 …”

Section: Discussionmentioning

confidence: 82%

An experimental study on intraoperative recovery of recurrent laryngeal nerve function

Setså

Svendsen

Husby

et al. 2020

Laryngoscope Investig Oto

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Objective: If bilateral thyroid surgery is planned and staged thyroidectomy considered in case of loss of neuromonitoring signal (LOS), a waiting time of 20 minutes is suggested for evaluation of early nerve recovery. This recommendation is based on clinical observations and has not been thoroughly validated experimentally. Methods: Sixteen pigs were randomly studied, and electromyogram (EMG) was continuously recorded during traction injury until an amplitude decrease of 70% from baseline (BL) (16 nerves) or LOS (16 nerves), and further during 40-minute recovery time. At the end of the experiments, vocal cord twitch was evaluated by videolaryngoscopy. Results: In the 70% group, 8 of 16 nerves recovered to or above an amplitude of 50% of baseline after 20 minutes and finally one more after 40 minutes. In the LOS group, only one nerve showed recovery after 20 minutes and one more after 40 minutes. Video-laryngoscopy revealed good or strong vocal cord twitches, in 10 of 14 nerves in the 70% group and in only 2 of 14 nerves in the LOS group. Conclusions: The overall intraoperative recovery was low after LOS. Even after 70% amplitude depression, only half of the nerves showed recovery to amplitudes ≥50% of BL. Nerve recovery is dynamic, and a waiting time of 20 minutes seems appropriate for the identification of early nerve recovery before decisions are taken to continue or terminate surgery. The final EMG amplitude was not always well correlated with estimated vocal cord twitch, evaluated by video-laryngoscopy. This observation needs further investigation. K E Y W O R D S intraoperative neuromonitoring, recurrent laryngeal nerve recovery, vocal cord twitch 1 | INTRODUCTION Implementation of continuous intraoperative neuromonitoring (C-IONM) gives the opportunity to real-time surveillance of the recurrent laryngeal nerve (RLN) during thyroid mobilization and nerve dissection. C-IONM compared to intermittent IONM (I-IONM) recognizes impending nerve injury and enables the assessment of intraoperative recovery of nerve function after loss of the

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Section: Discussionmentioning

confidence: 82%

An experimental study on intraoperative recovery of recurrent laryngeal nerve function

Setså

Svendsen

Husby

et al. 2020

Laryngoscope Investig Oto

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“…In contrast, Setså et al were unable to demonstrate a strong correlation between EMG values at 20 or 40‐min recovery time and the VC movement, when assessed by video‐laryngoscopy directly following extubation 15 . However, based on the strong correlation between EMG and VC movement obtained by ACC during nerve injury, as demonstrated by Dahle et al, 10 we would expect its existence also during the recovery phase. This study was therefore performed to thoroughly evaluate the relationship between EMG and VC movement assessed by ACC during 40‐min recovery following nerve stress by traction.…”

Section: Introductionmentioning

confidence: 81%

“…For perioperative registration of VC movement, an accelerometer probe was used. A complete presentation of the instrumental construction, design, and setup was recently presented 17 . The accelerometer probe was placed into the VC via a rigid diverticuloscope (12068B, Karl Storz SE & Co. KG, Tuttlingen, Germany) and cable‐connected to the controller unit.…”

Section: Methodsmentioning

confidence: 99%

“…A complete presentation of the instrumental construction, design, and setup was recently presented. 17 The accelerometer probe was placed into the VC via a rigid diverticuloscope (12068B, Karl Storz SE & Co. KG, Tuttlingen, Germany) and cable-connected to the controller unit. The controller unit read the probe values at a regular rate and streamed the data to a PC.…”

Section: Surgical Preparation Electromyography and Accelerometrymentioning

confidence: 99%

“…This evident clinical discrepancy raised the question about the correlation between the electromyogram (EMG) measurement obtained by IONM, and the real movement of the vocal cord (VC). In an experimental study, Dahle et al compared EMG changes with the movement of the VC assessed by accelerometry (ACC) during ongoing nerve injury 10 . They found a strong correlation between changes in EMG and VC movement.…”

Section: Introductionmentioning

confidence: 99%

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Accelerometry May be Superior to EMG for Early Evaluation of Vocal Cord Function After Nerve Injury in a Pig Model

Setså,

Svendsen,

Henriksen

et al. 2023

The Laryngoscope

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ObjectiveVocal cord (VC) movement has been demonstrated by the use of accelerometry (ACC) to decrease in parallel with the electromyographic amplitude (EMG) during ongoing traction injury to the recurrent laryngeal nerve (RLN). When RLN function recovers, discrepancies between EMG and VC movement have been reported in clinical and experimental studies. The present study was conducted to clarify the actual relationship between EMG and VC movement measured by ACC during nerve recovery.MethodsEMG obtained by continuous nerve monitoring (C‐IONM) was compared with ACC during traction injury to the RLN, and throughout 40‐min nerve recovery. A three‐axis linear accelerometer probe was attached to the VC, and ACC data were registered as described. Traction damage was applied to the RLN until there was a 70% amplitude decrease from baseline EMG, or until loss of signal (LOS), that is, EMG values ≤100 μV.ResultsThirty‐two RLN from 16 immature pigs were studied. Correlation between EMG and ACC were calculated during nerve injury and nerve recovery. The mean correlations were for the 70% and LOS group from start to end of traction: 0.82 (±0.17) and 0.87 (±0.17), respectively. Corresponding correlation coefficients during 40‐min recovery was 0.50 (±0.48) in the 70% group and 0.53 (±0.33) in the LOS group.ConclusionThere is a high correlation between EMG and VC movement during nerve injury, and a moderate correlation during early nerve recovery. EMG recovery after RLN injury ensures sufficient VC function as assessed by ACC.Level of EvidenceN/A Laryngoscope, 2023

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A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides

Liu,

Yan,

et al. 2024

Laryngoscope Investig Oto

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ObjectiveTo assess the extent of recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) damage in patients with idiopathic vocal cord paralysis (IVCP) exhibiting different paralytic sides.MethodsA total of 84 IVCP cases were evaluated using stroboscopic laryngoscopy, voice analysis, and laryngeal electromyography (LEMG). The results were compared between patients with left‐sided paralysis and right‐sided paralysis based on different disease courses (less than or more than 3 months).ResultsInitially, the average age and disease progression of IVCP patients were found to be similar regardless of the side of paralysis (p > .05). Additionally, there were no significant variations in voice indicators, such as MPT, DSI, and VHI, between IVCP patients with left and right vocal cord paralysis (p > .05). Furthermore, no disparities were detected in the latencies and amplitudes of the paralyzed RLN and SLN, as well as the durations and amplitudes of the action potentials in the paralyzed TM and PCM, among IVCP patients with left and right vocal cord paralysis (p > .05). Notably, the amplitudes of the left paralytic CM were significantly lower than those of the right paralytic CM (0.45 vs. 0.53, Z = −2.013, p = .044). In addition, no disparities were observed in APDs and amplitudes between the ipsilateral PCM and TM, either for patients with left or right vocal fold paralysis (p > .05). Finally, all the IVCP patients were subdivided into two subgroups according to different disease course (less than or more than 3 months), and in each subgroup, the comparison of voice indicators and LEMG results in IVCP patients with left or right vocal fold paralysis were similar with the above findings (p > .05).ConclusionOverall, the degree of RLN and SLN damage appeared to be similar in IVCP patients with left and right vocal cord paralysis, provided that the disease course was comparable.Level of Evidence4.

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Vocal cord function during recurrent laryngeal nerve injury assessed by accelerometry and EMG

Cited by 6 publications

References 26 publications

An experimental study on intraoperative recovery of recurrent laryngeal nerve function

An experimental study on intraoperative recovery of recurrent laryngeal nerve function

Accelerometry May be Superior to EMG for Early Evaluation of Vocal Cord Function After Nerve Injury in a Pig Model

A comparative analysis of laryngeal nerve damage in patients with idiopathic vocal cord paralysis exhibiting different paralytic sides

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