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Quindlen CE, Alnouri G, Sataloff RT. Safety of Laryngeal Electromyography and Repetitive Stimulation. J Voice 2023:S0892-1997(22)00398-8. [PMID: 36725410 DOI: 10.1016/j.jvoice.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Laryngeal Electromyography (LEMG) is a procedure used to assess electrical signals from laryngeal muscles. It is considered to be the gold standard test for examining vocal fold paresis/paralysis. Repetitive stimulation studies, which usually are performed at the time of LEMG, can aid in assessment of neuromuscular function. Electromyography poses risks to the patient due to the use of electricity and needles. The purpose of this paper was to evaluate the safety of LEMG and discuss the possible complications. METHODS This was a retrospective review of patients from January 2015 through February 2022. Information from patient charts included age, sex, chief complaint, past medical history, family medical history, medications, social history, strobovideolaryngoscopy results, type of paresis, professional voice user status, presence of pacemaker, laryngeal electromyography and repetitive stimulation study results, and reported complications. Complications were considered to be anything that differed from the norm. Pain was included as a complication. Data were analyzed for relationships and significance. RESULTS Five hundred patients were included. Eighteen of the 500 (3.6%) experienced complications. Four (2.1%) males and 14 (4.5%) females experienced complications. Nine of the 18 (50%) reported pain after the procedure, 1 (5.56%) had excessive bleeding (controlled with pressure), 5 (27.78%) reported voice changes, and 3 (16.67%) experienced difficulty with completion of the procedure. No patients with pacemakers or patients taking anticoagulants had complications, but repetitive stimulation studies were not performed on patients with pacemakers. CONCLUSIONS LEMG and repetitive stimulation studies are safe and effective procedures to examine laryngeal muscles. Repetitive stimulation studies are not recommended for patients with pacemakers.
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Affiliation(s)
| | - Ghiath Alnouri
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.
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Functional outcomes after transoral CO 2 laser treatment for posterior glottic stenosis: a bicentric case series. Eur Arch Otorhinolaryngol 2023; 280:249-257. [PMID: 35819506 DOI: 10.1007/s00405-022-07516-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/14/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE The aim of this study is to evaluate functional outcomes in terms of decannulation rate and quality of life of patients affected by PGS (Grades I-IV) treated only by transoral CO2 laser microsurgery (TOLMS) in two tertiary centers. METHODS An observational retrospective study was carried out, enrolling 22 patients affected by PGS who were treated by a transoral approach at two tertiary referral centers. Surgical treatment included TOLMS with tailored laser resection of the scar tissue combined with posterior cordotomy, resurfacing of the raw area with mucosal microflap, or placement of a Montgomery T-tube or Keel stent. All patients were evaluated and staged preoperatively and postoperatively, at least 6 months after the surgery. Functional outcomes were objectively evaluated by the Airway-Dysphonia-Voice-Swallowing (ADVS) staging system, Voice Handicap Index-30 (VHI-30), and Eating Assessment Tool-10 (EAT-10) questionnaires. RESULTS Quality of life significantly improved as measured by the VHI-30 questionnaire with a median variation of - 31.0 (p = 0.003), the EAT-10 with a median variation of - 4.0 (p = 0.042), and the ADVS with a median variation of - 3.5 (p < 0.001). No significant changes were observed in swallowing scores. We were able to decannulate 7 of 9 patients (almost 80%) with previous tracheotomy. CONCLUSION In conclusion, even if there is still no general agreement on an exact therapeutic algorithm to treat PGS, our results confirm that transoral surgery, in terms of scar tissue removal, combined in selected patients with posterior cordotomy and pedicled local flaps and/or placement of stents, represents a safe and effective surgical approach even for more severe PGS.
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Belsky MA, Lin RJ, Rosen CA, Munin MC, Smith LJ. Vocal fold injection material does not preclude interpretation of laryngeal electromyography. Muscle Nerve 2021; 64:104-108. [PMID: 33961288 DOI: 10.1002/mus.27262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 04/26/2021] [Accepted: 05/04/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION/AIMS Temporary vocal fold injection (VFI) is a common treatment for acute and subacute vocal fold paralysis (VFP). Laryngeal electromyography (LEMG) is useful for diagnosing neurogenic causes of VFP. This study evaluated whether the presence of VFI material prevents interpretation of LEMG in patients with acute and subacute VFP. METHODS Patients with acute and subacute unilateral VFP (onset ≤6 mo) who underwent temporary VFI within 3 mo preceding LEMG were evaluated. A matched control group that did not undergo VFI was also studied. The LEMG team (laryngologist and electromyographer) performed and interpreted LEMG using a pre-specified protocol, including qualitative and quantitative motor unit analysis. RESULTS Eighteen patients with VFI underwent LEMG successfully with interpretation of spontaneous activity and motor unit recruitment. Fourteen patients were seen in follow-up to determine accuracy of established LEMG prognosis. Seven of seven subjects with poor LEMG prognosis did not recover vocal fold motion. Five of seven subjects with fair LEMG prognosis recovered vocal fold motion. Findings were similar for the control group. DISCUSSION VFI augmentation material did not prevent interpretation of meaningful LEMG data in patients with acute and subacute VFP, and accurate prognoses of vocal fold motion recovery were established.
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Affiliation(s)
- Michael A Belsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - R Jun Lin
- Department of Otolaryngology - Head & Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Clark A Rosen
- UCSF Voice and Swallowing Center, Division of Laryngology, Department of Otolaryngology - Head & Neck Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael C Munin
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Libby J Smith
- Department of Otolaryngology, University of Pittsburgh Voice Center, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Selim J, Maquet C, Djerada Z, Besnier E, Compère V, Crampon F, Clavier T, Marie JP. Anesthetic Management for Awake Tubeless Suspension Microlaryngoscopy. Laryngoscope 2021; 131:E2669-E2675. [PMID: 33881167 DOI: 10.1002/lary.29565] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/31/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Patients' eligibility for bilateral selective laryngeal reinnervation surgery is evaluated by suspension microlaryngoscopy (SML) examination with laryngeal electromyography (LEMG). Maintaining spontaneous ventilation, with remifentanil sedation/analgesia without endotracheal tube, to allow the patient to phonate with the surgeon during awake, LEMG is a major challenge for the anesthesiologist and the otorhinololaryngologist. The objective of this study was to evaluate the safety and efficacy of a novel anesthesia protocol to manage airway access during awake tubeless SML. STUDY DESIGN Retrospective study. METHODS Anesthesia records of patients undergoing awake SML with LEMG were retrospectively analyzed. Procedures were performed with remifentanil sedation/analgesia with targeted controlled infusion (TCI) in combination with local anesthesia. The main outcome was the failure rate of the anesthesia protocol during the procedure. Secondary outcomes were as follows: rate of apnea requiring ventilation, airway bleeding, regurgitation, hemodynamic data as well as vasopressor use, complications, and surgeon satisfaction with the procedure. RESULTS Data were obtained for 39 patients between November 2017 and September 2019, the mean age was 52 years and 29 (74%) were female. All procedures were completed without complications (0% [0-9]). Three patients (8% [1.6-20.8]) had an intraoperative episode of hypoxemia requiring mask reventilation. There was no airway bleeding, no regurgitation, and no hypotensive episode. Three patients (8% [1.6-20.8]) had noninvasive ventilation for respiratory distress after the end of the procedure. CONCLUSIONS Our results show that awake tubeless SML allowing phonation during LEMG can be realized under sedation and local anesthesia. However, further data are needed concerning the intraoperative and postoperative safety of the procedure. LEVEL OF EVIDENCE 4. Laryngoscope, 2021.
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Affiliation(s)
- Jean Selim
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Charles Maquet
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Zoubir Djerada
- Department of Pharmacology, EA3801, Reims University Hospital, Reims Cedex, France
| | - Emmanuel Besnier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Vincent Compère
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Frédéric Crampon
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen, France
| | - Thomas Clavier
- Department of Anesthesiology and Critical Care, Rouen University Hospital, Rouen, France.,Normandy University, UNIROUEN, INSERM U1096, Rouen, France
| | - Jean-Paul Marie
- Department of Otorhinolaryngology-Head and Neck Surgery, Rouen University Hospital, Rouen, France.,EA 3830 GRHV, Research Group on Ventilatory Handicap, University of Rouen Normandy, Rouen, France
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Fiorelli RKA, Duarte AJV, Quadros Teixeira A, Montenegro TS, Portari Filho PE, Morard MRS, da Silva Ascenção AM, Oliveira CAB, Novellino P. Anatomical and developmental aspects of iatrogenic injury to the right recurrent laryngeal nerve in surgical resections of substernal goiter. Anat Rec (Hoboken) 2021; 304:1242-1254. [DOI: 10.1002/ar.24629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/16/2021] [Accepted: 03/16/2021] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Aline Quadros Teixeira
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Thiago Scharth Montenegro
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Pedro Eder Portari Filho
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | - Maria Ribeiro Santos Morard
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
| | | | | | - Pietro Novellino
- Hospital Universitario Gaffree e Guinle, Universidade Federal do Estado do Rio de Janeiro Rio de Janeiro Brazil
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Pediatric Unilateral Vocal Fold Movement Impairment: Diagnostic Tools and Management Strategies. CURRENT OTORHINOLARYNGOLOGY REPORTS 2021. [DOI: 10.1007/s40136-020-00319-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zee H, Song SA, Sahani N, Macias AA, Song PC, Juang J. Successful Use of High-Flow Nasal Cannula for Concurrent Vocal Cord Electromyography and Tubeless Microlaryngeal Surgery in a Spontaneously Breathing Adult Patient: A Case Report. A A Pract 2020; 14:99-101. [PMID: 31842194 DOI: 10.1213/xaa.0000000000001154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ventilation during microlaryngoscopy previously included jet ventilation, microlaryngeal endotracheal tubes, and extended apnea. Historically, apneic oxygenation provided a tubeless field but limited operative time. Increased utilization of high-flow nasal cannula in intensive care units and operating rooms has created new opportunities to expand tubeless microlaryngoscopy. Although few studies have described high-flow nasal cannula for microlaryngoscopy, there remains much to be explored. In this case report, we describe the unique setting of utilizing high-flow nasal cannula in a spontaneously breathing patient to create an optimal tubeless surgical field for both microlaryngoscopy and vocal cord electromyography.
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Affiliation(s)
- Howard Zee
- From the Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sungjin A Song
- Harvard Medical School, Boston, Massachusetts.,Departments of Otolaryngology
| | - Nita Sahani
- Harvard Medical School, Boston, Massachusetts.,Anesthesiology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Alvaro Andres Macias
- Harvard Medical School, Boston, Massachusetts.,Anesthesiology, Massachusetts Eye and Ear, Boston, Massachusetts
| | - Phillip C Song
- Harvard Medical School, Boston, Massachusetts.,Departments of Otolaryngology
| | - Jeremy Juang
- Harvard Medical School, Boston, Massachusetts.,Anesthesiology, Massachusetts Eye and Ear, Boston, Massachusetts
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Vocal fold paresis: Medical specialists' opinions on standard diagnostics and laryngeal findings. Eur Arch Otorhinolaryngol 2018; 275:2535-2540. [PMID: 30141109 DOI: 10.1007/s00405-018-5102-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE There is still no clear consensus on the diagnostic value of specific laryngeal findings in patients with suspected vocal fold paresis (VFP). The aim of the study was to establish expert opinion on criteria for the diagnosis of VFP in Europe. METHODS A cross-sectional survey using the questionnaire introduced by Wu and Sulica for US American experts was addressed to laryngeal experts in Germany, Austria, and Switzerland and in a second survey wave to members of the European Laryngological Society. RESULTS 100 respondents returned survey 1 (response rate 47.2%). 26% worked at a university department. 28% regularly used laryngeal electromyography (LEMG). A pathologic test results in LEMG was considered to have the strongest positive predictive value for VFP (79 ± 23%), followed by a decreased vocal fold abduction (70 ± 29%), decreased vocal fold adduction (61 ± 34%), and atrophy of the hemilarynx (61 ± 31%). The multivariate analysis showed the predictive value of LEMG was estimated lower by respondents from non-university hospital (β = - 16.33; confidence interval (CI) = - 25.63 to - 7.02; p = 0.001) and higher in hospitals with higher frequency of VFP patients per months (β = 1.57; CI = - 0.98 to 2.16; p < 0.0001). 30 ELS members returned survey 2 (response rate, 8.4%). Their answers were not significantly different to survey 1. CONCLUSIONS The laryngology experts in Europe rely on LEMG for diagnosis of VFP like the US American experts, but paradoxically only a minority uses LEMG frequently. Next to LEMG, motion abnormities were considered to have the best predictive value for the diagnosis of VFP.
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10
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Kim MH, Noh J, Pyun SB. Comparison of Clinical Characteristics Between Patients With Different Causes of Vocal Cord Immobility. Ann Rehabil Med 2017; 41:1019-1027. [PMID: 29354579 PMCID: PMC5773422 DOI: 10.5535/arm.2017.41.6.1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/27/2017] [Indexed: 11/05/2022] Open
Abstract
Objective To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI). Methods The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group. Results Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched 'e' sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched 'e' sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018). Conclusion In patients with suspected vocal cord palsy, impaired high pitched 'e' sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.
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Affiliation(s)
- Min-Hyun Kim
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Junsoo Noh
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea
| | - Sung-Bom Pyun
- Department of Physical Medicine and Rehabilitation, Korea University College of Medicine, Seoul, Korea.,Brain Convergence Research Center, Korea University Anam Hospital, Seoul, Korea
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O'Connell Ferster AP, Hu A. Perceptions of pain of laryngeal electromyography. Laryngoscope 2017; 128:896-900. [DOI: 10.1002/lary.26860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/21/2017] [Accepted: 07/24/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Ashley P. O'Connell Ferster
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery; Penn State Health: Milton S. Hershey Medical Center; Hershey
| | - Amanda Hu
- Department of Otolaryngology-Head & Neck Surgery; Drexel University College of Medicine; Philadelphia Pennsylvania U.S.A
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