CLINICAL RESEARCH ARTICLE

Pilot study of a novel transmembranous electromyography device for assessment of oral cavity and oropharyngeal muscles

Deepak Menon MD, DM

orcid.org/0000-0001-7360-417X

Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada

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Perry Mansfield MD,

Perry Mansfield MD

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Derrick Cordice BS,

Derrick Cordice BS

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Chris Studer BS,

Chris Studer BS

Powell Mansfield, Inc, San Diego, California, USA

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Michael O'Leary MD,

Michael O'Leary MD

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Geoffrey Sheean MD,

Geoffrey Sheean MD

Powell Mansfield, Inc, San Diego, California, USA

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Vera Bril MD, FRCP(C),

Corresponding Author

Vera Bril MD, FRCP(C)

[email protected]

orcid.org/0000-0002-5805-4883

Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada

Correspondence

Vera Bril, Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, 5EC-309, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.

Email: [email protected]

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Deepak Menon MD, DM,

Deepak Menon MD, DM

orcid.org/0000-0001-7360-417X

Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada

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Perry Mansfield MD,

Perry Mansfield MD

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Derrick Cordice BS,

Derrick Cordice BS

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Chris Studer BS,

Chris Studer BS

Powell Mansfield, Inc, San Diego, California, USA

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Michael O'Leary MD,

Michael O'Leary MD

Division of Otolaryngology – Head and Neck Surgery, Senta Clinic, San Diego, California, USA

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Geoffrey Sheean MD,

Geoffrey Sheean MD

Powell Mansfield, Inc, San Diego, California, USA

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Vera Bril MD, FRCP(C),

Corresponding Author

Vera Bril MD, FRCP(C)

[email protected]

orcid.org/0000-0002-5805-4883

Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, Toronto, Ontario, Canada

Correspondence

Vera Bril, Ellen & Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, University of Toronto, 5EC-309, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada.

Email: [email protected]

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First published: 24 December 2021

https://doi.org/10.1002/mus.27479

Citations: 2

Funding information: Powell Mansfield Inc.

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Abstract

Introduction/Aims

Electromyography (EMG) can provide valuable insights into the pathophysiology of oropharyngeal muscles in various disease states, but the invasive nature of the conventional needle EMG (nEMG) has its limitations in this setting. We aimed to examine the inter-rater reliability (IRR) of a novel transmembranous EMG (tmEMG) sensor as a non-invasive technique for assessment of oral cavity and oropharyngeal muscles for neuromuscular pathology.

Methods

The study was a prospective, cohort, pilot study with blinded data analysis in healthy participants (n = 6), patients with moderate to severe obstructive sleep apnea (OSA) (n = 5) and bulbar amyotrophic lateral sclerosis (ALS) (n = 5). Each patient underwent sampling from bilateral palatoglossus (PG) and genioglossus (GG), using both tmEMG and nEMG. IRR was expressed as percentage agreement and prevalence-adjusted bias-adjusted kappa coefficient (PABAK).

Results

Substantial IRR was found for participants with ALS (81.6%, PABAK 0.63) and OSA (78.8%, PABAK 0.61), and in healthy participants (87.1%, PABAK 0.74). A better IRR was seen with tmEMG (95.7%, PABAK 0.92) than with nEMG (73.9%, PABAK 0.48) for healthy participants and also for those with OSA. Studies from GG had higher IRR than PG. Only one participant had a minor adverse event (sore throat).

Discussion

The current study shows that analysis of PG and GG in both healthy and disease states using tmEMG has high IRR compared with nEMG analysis. Further validation studies can be undertaken to test its utility in analysis of oral cavity and oropharyngeal muscles.

CONFLICTS OF INTEREST

Dr. Mansfield, Dr. Bril, and Mr. Studer have equity ownership in Powell Mansfield, Inc. Dr. Sheean, Dr. O'Leary, and Mr. Cordice serve or have served as consultants to Powell Mansfield, Inc.

Open Research

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request

Supporting Information

Filename	Description
mus27479-sup-0001-Tables.docxWord 2007 document , 17.2 KB	Table S1 Classification of the tmEMG recordings by the two raters in healthy subjects Table S2. Classification of the nEMG recordings by the two raters in healthy subjects Table S3. Classification of the tmEMG recordings by the two raters in subjects with OSA Table S4. Classification of the nEMG recordings by the two raters in subjects with OSA Table S5: Classification of the tmEMG recordings by the two raters in subjects with ALS Table S6: Classification of the nEMG recordings by the two raters in subjects with ALS
mus27479-sup-0002-FigureS1.jpgimage/jpg, 114.2 KB	Figure S1 showing screening process for healthy participants
mus27479-sup-0003-VideoS1.mp4MPEG-4 video, 1.6 MB	Video S1 Legend for media file 1: 10 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from right palatoglossus muscle obtained from the same healthy subject as media file 1, using transmembranous EMG (tmEMG) probe electrode during activation. Note the similarity of amplitude and morphology in the transmembranous and needle recordings, including the amplitude, sharp rise time, high frequency components, and well-defined, low-amplitude turns in the motor unit action potentials.
mus27479-sup-0004-VideoS2.mp4MPEG-4 video, 2.6 MB	Video S2 Legend for media file 2: 10 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from right palatoglossus muscle obtained from a healthy subject using a concentric needle EMG electrode during activation.
mus27479-sup-0005-VideoS3.mp4MPEG-4 video, 1.3 MB	Video S3 Legend for Media File 3: 6 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from right genioglossus muscle from a patient with ALS obtained using transmembranous EMG (tmEMG) probe electrode during activation. This recording demonstrates a neurogenic pattern.
mus27479-sup-0006-VideoS4.mp4MPEG-4 video, 802.9 KB	Video S4 Legend for Media File 4: 3 s epoch of EMG recording (500 microvolt gain, 10 ms per division sweep speed) from left genioglossus muscle from a patient with ALS obtained using needle electrode during activation. This recording demonstrates a neurogenic pattern. Note that this recording was from a different subject and side of the tongue than the recording in media file 3.
mus27479-sup-0007-VideoS5.mp4MPEG-4 video, 1.8 MB	Video S5 Legend for media file 5: 10 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from right palatoglossus muscle obtained from a patient with OSA using transmembranous EMG (tmEMG) probe electrode during activation.
mus27479-sup-0008-VideoS6.mp4MPEG-4 video, 808 KB	Video S6 Legend for media file 6: 10 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from right palatoglossus muscle obtained from a patient with OSA using needle electrode during activation.
mus27479-sup-0009-VideoS7.mp4MPEG-4 video, 2.5 MB	Video S7 Legend for Media file 7: 10 s epoch of EMG recording (200 microvolt gain, 10 ms per division sweep speed) from a healthy subject, obtained by a (transcutaneous) surface recording over the right abductor pollicis brevis. Silver/silver chloride discs placed in a belly-tendon montage were used for recording. Note the broad waveforms, with slow rise times and lack of high frequency and low amplitude turns in comparison with the transmembranous recording in media file 2.

Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

REFERENCES

1Almirall J, Rofes L, Serra-Prat M, et al. Oropharyngeal dysphagia is a risk factor for community-acquired pneumonia in the elderly. Eur Respir J. 2013; 41(4): 923-928.
10.1183/09031936.00019012
PubMed Web of Science® Google Scholar
2Attrill S, White S, Murray J, Hammond S, Doeltgen S. Impact of oropharyngeal dysphagia on healthcare cost and length of stay in hospital: a systematic review. BMC Health Serv Res. 2018; 18(1): 594.
10.1186/s12913-018-3376-3
PubMed Web of Science® Google Scholar
3Speyer R. Oropharyngeal dysphagia: screening and assessment. Otolaryngol Clin North Am. 2013; 46(6): 989-1008.
10.1016/j.otc.2013.08.004
PubMed Web of Science® Google Scholar
4Alfonsi E, Bergamaschi R, Cosentino G, et al. Electrophysiological patterns of oropharyngeal swallowing in multiple sclerosis. Clin Neurophysiol. 2013; 124(8): 1638-1645.
10.1016/j.clinph.2013.03.003
CAS PubMed Web of Science® Google Scholar
5Alfonsi E, Cosentino G, Mainardi L, et al. Electrophysiological investigations of shape and reproducibility of oropharyngeal swallowing: interaction with bolus volume and age. Dysphagia. 2015; 30(5): 540-550.
10.1007/s00455-015-9634-1
PubMed Web of Science® Google Scholar
6Ertekin C. Electrophysiological evaluation of oropharyngeal dysphagia in Parkinson's disease. J Mov Disord [Internet]. 2014; 7(2): 31-56.
10.14802/jmd.14008
PubMed Google Scholar
7Perlman AL, Palmer PM, McCulloch TM, Vandaele DJ. Eletromyographic activity from human laryngeal, pharyngeal, and submittal muscles during swallowing. Journal of Applied Physiology. 1999; 86(5): 1663-1669.
10.1152/jappl.1999.86.5.1663
CAS PubMed Web of Science® Google Scholar
8Boyd JH, Petrof BJ, Hamid Q, Fraser R, Kimoff RJ. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med. 2004; 170(5): 541-546.
10.1164/rccm.200308-1100OC
PubMed Web of Science® Google Scholar
9Svanborg E. Upper airway nerve lesions in obstructive sleep apnea. Am J Respir Crit Care Med. 2001; 164(2): 187-189.
10.1164/ajrccm.164.2.2105010c
CAS PubMed Web of Science® Google Scholar
10Aboussouan LS, Mireles-Cabodevila E. Sleep-disordered breathing in neuromuscular disease: diagnostic and therapeutic challenges. Chest. 2017; 152(4): 880-892.
10.1016/j.chest.2017.03.023
PubMed Web of Science® Google Scholar
11Saboisky JP, Stashuk DW, Hamilton-Wright A, et al. Neurogenic changes in the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2012; 185(3): 322-329.
10.1164/rccm.201106-1058OC
PubMed Web of Science® Google Scholar
12Patel JA, Ray BJ, Fernandez-Salvador C, Gouveia C, Zaghi S, Camacho M. Neuromuscular function of the soft palate and uvula in snoring and obstructive sleep apnea: a systematic review. Am J Otolaryngol. 2018; 39(3): 327-337.
10.1016/j.amjoto.2018.03.006
PubMed Web of Science® Google Scholar
13Edström L, Larsson H, Larsson L. Neurogenic effects on the palatopharyngeal muscle in patients with obstructive sleep apnoea: a muscle biopsy study. J Neurol Neurosurg Psychiatry. 1992; 55: 916-920.
10.1136/jnnp.55.10.916
CAS PubMed Web of Science® Google Scholar
14Stålberg E, van Dijk H, Falck B, et al. Standards for quantification of EMG and neurography. Clin Neurophysiol [Internet]. 2019; 130(9): 1688-1729.
10.1016/j.clinph.2019.05.008
PubMed Web of Science® Google Scholar
15Meekins GD, So Y, Quan D. American Association of Neuromuscular & Electrodiagnostic medicine evidenced-based review: use of surface electromyography in the diagnosis and study of neuromuscular disorders. Muscle Nerve [Internet]. 2008; 38(4): 1219-1224.
10.1002/mus.21055
PubMed Web of Science® Google Scholar
16Merletti R, Farina D. Analysis of intramuscular electromyogram signals. Philos Transact A Math Phys Eng Sci. 2009; 367(1887): 357-368.
10.1098/rsta.2008.0235
PubMed Web of Science® Google Scholar
17Gechev A, Kane NM, Koltzenburg M, Rao DG, van der Star R. Potential risks of iatrogenic complications of nerve conduction studies (NCS) and electromyography (EMG). Clin Neurophysiol Pract [Internet]. 2016; 1: 62-66.
10.1016/j.cnp.2016.09.003
CAS PubMed Google Scholar
18McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb). 2012; 22(3): 276-282.
10.11613/BM.2012.031
PubMed Web of Science® Google Scholar
19Feinstein AR, Cicchetti DV. High agreement but low kappa: I. The problems of two paradoxes. J Clin Epidemiol. 1990; 43(6): 543-549.
10.1016/0895-4356(90)90158-L
CAS PubMed Web of Science® Google Scholar
20Cicchetti DV, Feinstein AR. High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol. 1990; 43(6): 551-558.
10.1016/0895-4356(90)90159-M
CAS PubMed Web of Science® Google Scholar
21Sim J, Wright CC. The kappa statistic in reliability studies: Use, interpretation, and sample size requirements. Phys Ther. 2005; 85(3): 257-268.
10.1093/ptj/85.3.257
PubMed Web of Science® Google Scholar
22Cunningham M. 242–2009: More than Just the Kappa Coefficient: A Program to Fully Characterize Inter-Rater Reliability between Two Raters. 2009; 7.
Google Scholar
23Xie Q. Agree or Disagree? A demonstration of an alternative statistic to Cohen’s kappa for measuring the extent and reliability of agreement between observers. 2013:12.
Google Scholar
24McCausland T, Bordoni B. Anatomy, head and neck, genioglossus muscle. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 [cited 2022 Jan 10]. https://www.ncbi.nlm.nih.gov/books/NBK545141/
Google Scholar
25Rathee M, Jain P. Anatomy, head and neck, palatoglossus muscle (Glossopalatinus, palatoglossal). StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2021 [cited 2022 Jan 10]. https://www.ncbi.nlm.nih.gov/books/NBK549823/
Google Scholar
26Daube JR, Rubin DI. Needle electromyography. Muscle & Nerve. 2009; 39(2): 244-270.
10.1002/mus.21180
PubMed Web of Science® Google Scholar
27 EMG Evaluation eof the Motor Unit - Electrophysiologic Biopsy: Overview, Indications, Equipment. 2020. https://emedicine.medscape.com/article/1846028-overview#a2
Google Scholar
28Raez MBI, Hussain MS, Mohd-Yasin F. Techniques of EMG signal analysis: detection, processing, classification and applications. Biol Proced Online [Internet]. 2006; 8: 11-35.
10.1251/bpo115
CAS PubMed Web of Science® Google Scholar
29Türker KS. Electromyography: some methodological problems and issues. Phys Ther. 1993; 73: 698-710.
10.1093/ptj/73.10.698
CAS PubMed Web of Science® Google Scholar
30Palmer JB, Tanaka E, Siebens AA. Electromyography of the Pharyngeal Musculature: Technical Considerations. 1989;5.
Google Scholar
31Kendall R, Werner RA. Interrater reliability of the needle examination in lumbosacral radiculopathy. Muscle Nerve [Internet]. 2006; 34(2): 238-241.
10.1002/mus.20554
CAS PubMed Web of Science® Google Scholar
32Narayanaswami P, Geisbush T, Jones L, et al. Critically re-evaluating a common technique. Neurology. 2016; 86(3): 218-223.
10.1212/WNL.0000000000002292
PubMed Web of Science® Google Scholar

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Volume65, Issue3

March 2022

Pages 303-310

Pilot study of a novel transmembranous electromyography device for assessment of oral cavity and oropharyngeal muscles

Abstract

Introduction/Aims

Methods

Results

Discussion

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

Information

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Pilot study of a novel transmembranous electromyography device for assessment of oral cavity and oropharyngeal muscles

Abstract

Introduction/Aims

Methods

Results

Discussion

CONFLICTS OF INTEREST

Open Research

DATA AVAILABILITY STATEMENT

Supporting Information

REFERENCES

Citing Literature

References

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