title: Intraoperative laryngeal electromyography in children with vocal fold immobility: a simplified technique.
abstract: OBJECTIVE
  The primary objective of this study was to determine whether a simplified technique for intraoperative laryngeal electromyography was feasible using standard nerve integrity monitoring electrodes and audiovisual digital recording equipment. Our secondary objective was to determine if laryngeal electromyography data provided any additional information that significantly influenced patient management.
  
  
  METHODS
  Between February 2006 and February 2007, 10 children referred to our institution with vocal fold immobility underwent intraoperative laryngeal electromyography of the thyroarytenoid muscles. A retrospective chart review of these 10 patients was performed after institutional review board approval.
  
  
  RESULTS
  Standard nerve integrity monitoring electrodes can be used to perform intraoperative laryngeal electromyography of the thyroarytenoid muscles in children. In 5 of 10 cases reviewed, data from laryngeal electromyography recordings meaningfully influenced the care of children with vocal fold immobility and affected clinical decision-making, sometimes altering management strategies. In the remaining 5 children, data supported clinical impressions but did not alter treatment plans. Two children with idiopathic bilateral vocal fold paralysis initially presented with a lack of electrical activity on one or both sides but went on to develop motor unit action potentials that preceded recovery of motion in both vocal folds.
  
  
  CONCLUSIONS
  Our findings suggest that standard nerve monitoring equipment can be used to perform intraoperative laryngeal electromyography and that electromyographic data can assist clinicians in the management of complex patients. Additionally, there may be a role for the use of serial intraoperative measurements in predicting recovery from vocal fold paralysis in the pediatric age group.
authors.affiliation: Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Scott
authors.forename: Peter Siao Tick
authors.initials: PS
authors.lastname: Chong
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hartnick
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007830:Larynx / Q000503:physiopathology*; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D012189:Retrospective Studies; D014826:Vocal Cord Paralysis / Q000503:physiopathology* / Q000601:surgery