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Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation.
Laryngoscope. 2018 Jul; 128(7):1628-1633.L

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.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery, University of Toronto, St. Michael's Hospital, Toronto, Ontario, Canada.the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh.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.the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh.the University of Pittsburgh Voice Center, Division of Laryngology, Department of Otolaryngology, University of Pittsburgh School of Medicine, University of Pittsburgh.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29355973

Citation

Lin, R Jun, et al. "Innervation Status in Chronic Vocal Fold Paralysis and Implications for Laryngeal Reinnervation." The Laryngoscope, vol. 128, no. 7, 2018, pp. 1628-1633.
Lin RJ, Smith LJ, Munin MC, et al. Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. Laryngoscope. 2018;128(7):1628-1633.
Lin, R. J., Smith, L. J., Munin, M. C., Sridharan, S., & Rosen, C. A. (2018). Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. The Laryngoscope, 128(7), 1628-1633. https://doi.org/10.1002/lary.27078
Lin RJ, et al. Innervation Status in Chronic Vocal Fold Paralysis and Implications for Laryngeal Reinnervation. Laryngoscope. 2018;128(7):1628-1633. PubMed PMID: 29355973.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation. AU - Lin,R Jun, AU - Smith,Libby J, AU - Munin,Michael C, AU - Sridharan,Shaum, AU - Rosen,Clark A, Y1 - 2018/01/22/ PY - 2017/03/31/received PY - 2017/10/25/revised PY - 2017/12/04/accepted PY - 2018/1/23/pubmed PY - 2019/4/23/medline PY - 2018/1/23/entrez KW - Chronic vocal fold paralysis KW - EMG KW - LEMG KW - laryngeal electromyography KW - laryngeal reinnervation KW - vocal cord paralysis KW - vocal fold paralysis SP - 1628 EP - 1633 JF - The Laryngoscope JO - Laryngoscope VL - 128 IS - 7 N2 - 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. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/29355973/Innervation_status_in_chronic_vocal_fold_paralysis_and_implications_for_laryngeal_reinnervation_ L2 - https://doi.org/10.1002/lary.27078 DB - PRIME DP - Unbound Medicine ER -