title: Acute prediction of laryngeal outcome during thyroid surgery by electromyographic laryngeal monitoring.
abstract: BACKGROUND
  The purpose of this study was to evaluate the contribution of laryngeal intraoperative nerve monitoring (IONM) during thyroidectomy in predicting postoperative laryngeal mobility.
  
  
  METHODS
  Between 2009 and 2012, 127 patients underwent thyroidectomy, during which 216 recurrent laryngeal nerves were stimulated with suprathreshold stimulations. Laryngeal mobility was examined through direct laryngoscopy. Statistical analysis was performed to determine specificity, sensitivity, negative predictive value (NPV), positive predictive value (PPV), and a threshold value in order to define a intraoperative diagnostic test.
  
  
  RESULTS
  Nine patients had a unilateral laryngeal palsy. No bilateral laryngeal palsy was observed. The threshold value to assure the postoperative laryngeal mobility is 280 μV. For this value, specificity was 94.06%, sensitivity 100%, NPV 100%, and PPV 47.83%.
  
  
  CONCLUSIONS
  Laryngeal IONM can predict a favorable outcome of laryngeal mobility in cases in which the response exceeds 280 μV. Under this value, the risk of palsy is about 50% suggesting a staged surgery.
authors.affiliation: Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Pavier
authors.affiliation: Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Saroul
authors.affiliation: Délégation Recherche Clinique and Innovation, Villa annexe IFSI, Hopital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Délégation Recherche Clinique and Innovation, Villa annexe IFSI, Hopital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Tauveron
authors.affiliation: Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-Faciale, Hôpital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Gilain
authors.affiliation: Service Diabétologie - Endocrinologie, Hopital Gabriel Montpied, CHU, Clermont-Ferrand, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Mom
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D007828:Laryngoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D012372:ROC Curve; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control*
keywords: diagnostic test; laryngeal bilateral palsy prevention; monitoring; negative predictive value; thyroid surgery