title: Intraoperative stimulation neuromonitoring versus intraoperative continuous electromyographic neuromonitoring in total thyroidectomy: identifying laryngeal complications.
abstract: BACKGROUND
  Laryngeal complications occur in thyroidectomies as a result of several factors, but especially because of nerve damage. We compared intraoperative stimulation neuromonitoring (IONM) with intraoperative continuous electromyographic neuromonitoring (IEM) to evaluate their ability to identify postoperative laryngeal complications.
  
  
  METHODS
  This prospective clinical trial included 174 patients (348 nerves) who had both IONM and IEM. We recorded age, sex, pathology, vocal fold motility, and complications.
  
  
  RESULTS
  IONM identified 334 nerves, whereas IEM identified 348. Five patients had transient laryngeal complications, 2 bilateral, and 3 unilateral recurrent laryngeal nerve paresis. In addition, in 2 patients IEM showed placement of the tracheal tube balloon on the vocal folds, which led to correction. Sensitivity and specificity were 96.48% and 100% for IONM and 100% and 100% for IEM, respectively. IONM had a positive predictive value of 100% and a negative predictive value of 36.84%. The positive and negative predictive values of IEM were 100%.
  
  
  CONCLUSIONS
  Both techniques identify recurrent laryngeal nerve injuries; however, IEM seems to have an advantage concerning the nonsurgical laryngeal complications and may play a role in preventing morbidity.
authors.affiliation: 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, 6 Aigaiou Str., Thessaloniki, Greece.
authors.forename: Charilaos
authors.initials: C
authors.lastname: Koulouris
authors.forename: Theodossis S
authors.initials: TS
authors.lastname: Papavramidis
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pliakos
authors.forename: Nick
authors.initials: N
authors.lastname: Michalopoulos
authors.forename: Michalis
authors.initials: M
authors.lastname: Polyzonis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Sapalidis
authors.forename: Isaak
authors.initials: I
authors.lastname: Kesisoglou
authors.forename: George
authors.initials: G
authors.lastname: Gkoutzamanis
authors.forename: Spiros T
authors.initials: ST
authors.lastname: Papavramidis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D014465:Ultrasonics