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Electromyography of the Larynx

  • Simon BriseboisEmail author
  • Allen D. Hillel
Chapter
  • 41 Downloads

Abstract

Laryngeal electromyography (LEMG) has evolved over the past decades to become a clinical diagnostic tool for the neuro-laryngologist. Its primary uses are for (1) signal guidance for injection into the laryngeal muscle, (2) diagnostic needle LEMG, (3) diagnostic fine-wire LEMG, and, less commonly, (4) compound muscle action potential evaluation. Indeed, use for botulinum toxin injection may help improve accuracy and effectiveness of treatment. LEMG can help to distinguish the etiology of vocal fold motion impairment or help predict recovery in paralysis cases to inform earlier surgical management. Neurologic conditions such as spasmodic dysphonia can be more precisely characterized which may help to optimize treatment with botulinum toxin. This chapter aims to provide a summary of the key concepts in LEMG interpretation, as well as instruments and techniques that are essential to the neuro-laryngologist. Better understanding of the audio and visual cues will allow for better yield during use of this technique.

Keywords

Neurolaryngology Laryngeal electromyography Fine-wire electromyography Vocal fold motion impairment Vocal fold paralysis Botulinum toxin injection Spasmodic dysphonia Synkinesis 

References

  1. 1.
    Weddell G, Feinstein B, Pattle RE. The electrical activity of voluntary muscle in man under normal and pathological conditions. Brain. 1944;67(3):178–257.CrossRefGoogle Scholar
  2. 2.
    Faaborg-Andersen K, Buchthal F. Action potentials from internal laryngeal muscles during phonation. Nature. 1956;177(4503):340–1.CrossRefGoogle Scholar
  3. 3.
    O’Connell Ferster AP, Hu A. Perceptions of pain of laryngeal electromyography. Laryngoscope. 2018;128(4):896–900.CrossRefGoogle Scholar
  4. 4.
    Heman-Ackah YD, Barr A. Mild vocal fold paresis: understanding clinical presentation and electromyographic findings. J Voice. 2006;20(2):269–81.CrossRefGoogle Scholar
  5. 5.
    Maronian NC, Robinson L, Waugh P, Hillel AD. A new electromyographic definition of laryngeal synkinesis. Ann Otol Rhinol Laryngol. 2004;113(11):877–86.CrossRefGoogle Scholar
  6. 6.
    Fulmer SL, Merati AL, Blumin JH. Efficacy of laryngeal botulinum toxin injection: comparison of two techniques. Laryngoscope. 2011;121(9):1924–8.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Munin MC, Heman-Ackah YD, Rosen CA, Sulica L, Maronian N, Mandel S, et al. Consensus statement: using laryngeal electromyography for the diagnosis and treatment of vocal cord paralysis. Muscle Nerve. 2016;53(6):850–5.CrossRefGoogle Scholar
  8. 8.
    Merati AL, Shemirani N, Smith TL, Toohill RJ. Changing trends in the nature of vocal fold motion impairment. Am J Otolaryngol. 2006;27(2):106–8.CrossRefGoogle Scholar
  9. 9.
    Rosenthal LHS, Benninger MS, Deeb RH. Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope. 2007;117(10):1864–70.CrossRefGoogle Scholar
  10. 10.
    Ingle JW, Young VN, Smith LJ, Munin MC, Rosen CA. Prospective evaluation of the clinical utility of laryngeal electromyography. Laryngoscope. 2014;124(12):2745–9.CrossRefGoogle Scholar
  11. 11.
    Paniello RC, Park AM, Bhatt NK, Al-Lozi M. Recurrent laryngeal nerve recovery patterns assessed by serial electromyography. Laryngoscope. 2016;126(3):651–6.CrossRefGoogle Scholar
  12. 12.
    Lin RJ, Smith LJ, Munin MC, Sridharan S, Rosen CA. Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. Laryngoscope. 2018;128(7):1628–33.CrossRefGoogle Scholar
  13. 13.
    Zarzur AP, Duprat A de C, Cataldo BO, Ciampi D, Fonoff E. Laryngeal electromyography as a diagnostic tool for Parkinson’s disease. Laryngoscope. 2014;124(3):725–9.CrossRefGoogle Scholar
  14. 14.
    Martins MP, Crespo AN, Kimaid PAA, Nucci A, Franca MC. F95. Laryngeal electromyography in patients with Amiotrophic lateral sclerosis (ALS): preliminary results. Clin Neurophysiol. 2018;129:e102.CrossRefGoogle Scholar
  15. 15.
    Alfonsi E, Terzaghi M, Cosentino G, Tassorelli C, Manni R, Pozzi N, et al. Specific patterns of laryngeal electromyography during wakefulness are associated to sleep disordered breathing and nocturnal stridor in multiple system atrophy. Parkinsonism Relat Disord. 2016;31:104–9.CrossRefGoogle Scholar
  16. 16.
    Sataloff RT, Mandel S, Mann EA, Ludlow CL. Practice parameter: laryngeal electromyography (an evidence-based review). Otolaryngol Head Neck Surg. 2004;130(6):770–9.CrossRefGoogle Scholar
  17. 17.
    Blitzer A, Crumley RL, Dailey SH, Ford CN, Floeter MK, Hillel AD, et al. Recommendations of the Neurolaryngology Study Group on laryngeal electromyography. Otolaryngol Head Neck Surg. 2009;140(6):782–93.CrossRefGoogle Scholar
  18. 18.
    Palmer JB, Holloway AM, Tanaka E. Detecting lower motor neuron dysfunction of the pharynx and larynx with electromyography. Arch Phys Med Rehabil. 1991;72(3):214–8.PubMedGoogle Scholar
  19. 19.
    Hillel AD. The study of laryngeal muscle activity in normal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography. Laryngoscope. 2001;111(4 Pt 2 Suppl 97):1–47.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Otolaryngology–Head and Neck Surgery, Department of SurgeryCentre Hospitalier Universitaire de SherbrookeSherbrookeCanada
  2. 2.Department of Otolaryngology–Head and Neck SurgeryUniversity of WashingtonSeattle, WashingtonUSA

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