Lack of Evoked Laryngeal Electromyography Response in Patients with a Clinical Diagnosis of Vocal Cord Paralysis

Abstract

There has been recent debate about whether patients with vocal cord immobility have a neurologic paralysis or whether synkinesis, the misdirection of axons to competing laryngeal muscles, is responsible for the lack of voluntary vocal cord motion. This issue was studied in 15 patients with vocal cord paralysis who underwent laryngeal reinnervation. Evoked electromyography was performed with a surface electrode endotracheal tube. The recurrent laryngeal nerve (RLN) was identified and stimulated with constant current. Of the 15 patients, only 1 produced a compound muscle action potential upon nerve stimulation. The remaining 14 patients had no evoked response during RLN stimulation. a control group of 8 patients with normal vocal cord mobility was studied, and each had a normal evoked electromyography response after RLN stimulation. These results support the assertion that patients who require treatment for vocal cord paralysis do not have synkinesis produced by RLN reinnervation.

Keywords

electromyography larynx paralysis synkinesis vocal cord

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References

Sanders

Biller

. The innervation of the human larynx. Arch Otolaryngol Head Neck Surg 1993; 119: 934–9.

Wagner

. Die Medianstellung der Stimmbandes bei Recurrenslähmung. Arch Pathol Anat Physiol 1890; 120: 437–59.

Grossmann

. Experimentelle Beitrage zur Lehre von der Posticuslähmung. Arch Laryngol Rhinol 1897; 6: 282–360.

Rosenbach

. Zur Lehre von doppelseitigen totalen Laehmung des Nerve laryngeus inferior (recurrens). Breslauer Aerztliche Z 1880; 2: 14–6, 27–30.

Semon

. Clinical remarks: On the proclivity of the abductor fibers of the recurrent laryngeal nerve to become affected sooner than the adductor fibers or even exclusively, in cases of undoubted central or peripheral injury or disease of the roots or trunks of the pneumogastric, spinal accessory or recurrent nerves. Arch Laryngol 1881; 2: 197–222.

Crumley

. Laryngeal synkinesis: Its significance to the laryngologist. Ann Otol Rhinol Laryngol 1989; 98: 87–92.

Mermelstein

Nonweiler

Rubinstein

. Intraoperative identification of laryngeal nerves with laryngeal electromyography. Laryngoscope 1996; 106: 752–6.

Chhetri

Gerratt

Kreiman

Berke

. Combined arytenoid adduction and laryngeal reinnervation in the treatment of vocal fold paralysis. Laryngoscope 1999: 109: 1928–36.

Benninger

Crumley

Ford

. Evaluation and treatment of the unilateral paralyzed vocal fold. Otolaryngol Head Neck Surg 1994; 111: 497–508.

10.

Woo

. Laryngeal electromyography is a cost-effective clinically useful tool in the evaluation of vocal fold function. Arch Otolaryngol Head Neck Surg 1998; 124: 472–5.

11.

Yin

Qiu

Stucker

. Value of electromyography in differential diagnosis of laryngeal joint injuries after intubation. Ann Otol Rhinol Laryngol 1996; 105: 446–51.

12.

Yin

Qiu

Stucker

. Major patterns of laryngeal electromyography and their clinical application. Laryngoscope 1997; 107: 126–36.

13.

Sataloff

Bough

Spiegel

. Arytenoid dislocation: Diagnosis and treatment. Laryngoscope 1994; 104: 1353–61.

14.

Hirano

Nozoe

Shin

Maeyama

. Electromyography for laryngeal paralysis. In: Hirano

Kirchner

Bless

, eds. Neurolaryngology: Recent advances. Boston, Mass: Little, Brown, 1987: 232–48.

15.

Pototschnig

Thumfart

. Electromyographic evaluation of vocal cord disorders. Acta Otorhinolaryngol Belg 1997; 51: 99–104.

16.

Nasri

Beizai

Sercarz

Kim

Berke

. Cross-innervation of the thyroarytenoid muscle by a branch from the external division of the superior laryngeal nerve. Ann Otol Rhinol Laryngol 1997; 106: 594–8.

17.

Sanders

Biller

. The human communicating nerve. An extension of the external superior laryngeal nerve that innervates the vocal cord. Arch Otolaryngol Head Neck Surg 1994; 120: 1321–8.

18.

Exner

. Die Innervation des Kehlkopfes. SB Akad Wiss (Wien) 1884; 89: 63–118.

19.

Exner

. Notiz zu der Frage von der Faser-vertheilung mehrerer Nerven in einem Muskel. Pflug Arch Ges Physiol 1885; 36: 572–6.

20.

Lewis

Crumley

Blanks

RHI

Pitcock

. Does intralaryngeal motor nerve sprouting occur following unilateral recurrent laryngeal nerve paralysis?. Laryngoscope 1991; 101: 1259–63.