Laryngology

Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation

Corresponding Author

R. Jun Lin MD

[email protected]

orcid.org/0000-0003-1064-5868

Department of Otolaryngology–Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada

Send correspondence to R. Jun Lin, MD, FRCSC, MSc, Assistant Professor, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, St. Michael's Hospital, 30 Bond Street, 8-163 CC, North Toronto, Ontario, Canada, M5B 1W8. E-mail: [email protected]Search for more papers by this author

Libby J. Smith DO,

Libby J. Smith DO

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

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Michael C. Munin MD,

Michael C. Munin MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

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Shaum Sridharan MD,

Shaum Sridharan MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

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Clark A. Rosen MD,

Clark A. Rosen MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

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R. Jun Lin MD,

Corresponding Author

R. Jun Lin MD

[email protected]

orcid.org/0000-0003-1064-5868

Department of Otolaryngology–Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada

Libby J. Smith DO,

Libby J. Smith DO

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

Search for more papers by this author

Michael C. Munin MD,

Michael C. Munin MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

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Shaum Sridharan MD,

Shaum Sridharan MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

Search for more papers by this author

Clark A. Rosen MD,

Clark A. Rosen MD

the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh

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First published: 22 January 2018

https://doi.org/10.1002/lary.27078

Citations: 22

Presented as a podium presentation at the American Laryngological Association (ALA) at Combined Otolaryngology Spring Meetings (COSM), San Diego, California, U.S.A., April 26, 2017.

The authors have no funding, financial relationships, or conflicts of interest to disclose.

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Abstract

Objective

Treatment options for symptomatic unilateral vocal fold paralysis (VFP) include vocal fold augmentation, laryngeal framework surgery, and laryngeal reinnervation. Laryngeal reinnervation (LR) has been suggested to provide “tone” to the paralyzed VF. This implies a loss of tone as a result of denervation without reinnervation. We performed laryngeal electromyography (LEMG) in patients with chronic VFP to understand the innervation status associated with a chronically paralyzed vocal fold.

Study Design

Retrospective review of LEMG data in adult patients with chronic VFP from January 2009 to December 2014.

Methods

LEMG was performed at least 6 months after-onset of VFP. Qualitative LEMG, quantitative LEMG, and adductory synkinesis testing were performed, and the parameters were collected.

Results

Twenty-seven vocal folds were studied (23 unilateral VFP and 2 bilateral VFP). Average age was 59 ± 17 years. The median duration from recurrent laryngeal nerve injury to LEMG was 8.5 months (range 6–90 months). The majority of patients, 24 of 27 (89%), had motor unit potentials during phonation tasks on LEMG, and only 3 of 27 (11%) patients were electrically silent. Quantitative LEMG showed 287.8 mean turns per second (normal ≥ 400). Motor unit configuration was normal in 12 of 27 (44%), polyphasic in 12 of 27 (44%), and absent in the electrically silent patients. Adductory synkinesis was found in 6 of 20 (30%) patients.

Conclusion

Chronic vocal fold paralysis is infrequently associated with absent motor-unit recruitment, indicating some degree of preserved innervation and/or reinnervation in these patients. LEMG should be part of the routine workup for chronic VFP prior to consideration of LR.

Level of Evidence

4. Laryngoscope, 128:1628–1633, 2018

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Citing Literature

Volume128, Issue7

July 2018

Pages 1628-1633

Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation

Abstract

Objective

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Information

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Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation

Abstract

Objective

Study Design

Methods

Results

Conclusion

Level of Evidence

BIBLIOGRAPHY

Citing Literature

References

Related

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