Relationship Between Laryngeal Electromyography and Video Laryngostroboscopy in Vocal Fold Paralysis.
OBJECTIVE
The objective of this study was to better define the relationship of laryngeal electromyography and video laryngostroboscopy in the diagnosis of vocal fold paralysis.


METHODS
Retrospective diagnostic cohort study with cross-sectional data analysis METHODS: Data were obtained from 57 patients with unilateral vocal fold paralysis who attended a large tertiary voice referral center. Electromyographic findings were classified according to recurrent laryngeal nerve, superior laryngeal nerve, and high vagal/combined lesions. Video laryngostroboscopy recordings were classified according to the position of the immobile fold into median, paramedian, lateral, and a foreshortened/hooded vocal fold. The position of the paralyzed vocal fold was then analyzed according to the lesion as determined by electromyography.


RESULTS
The recurrent laryngeal nerve was affected in the majority of cases with left-sided lesions more common than right. Vocal fold position differed between recurrent laryngeal and combined vagal lesions. Recurrent laryngeal nerve lesions were more commonly associated with a laterally displaced immobile fold. No fold position was suggestive of a combined vagal lesion. The inter-rater reliability for determining fold position was high.


CONCLUSIONS
Laryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. Such findings indicate that further unknown mechanisms contribute to fold position in unilateral paralysis.
School of Medicine, University of Notre Dame, Sydney, Australia. Electronic address: joelmaamary@gmail.com.
Joel A
JA
Maamary
Department of Laryngology, The St Vincent's Hospital, Sydney, Australia; Voice Assessment Centre, The St Vincent's Clinic, Sydney, Australia.
Ian
I
Cole
Department of Neurophysiology, The St Vincent's Hospital, Sydney, Australia.
Paul
P
Darveniza
Voice Assessment Centre, The St Vincent's Clinic, Sydney, Australia.
Cecilia
C
Pemberton
Department of Speech Pathology, The St Vincent's Hospital, Sydney, Australia.
Helen Mary
HM
Brake
Department of Neurophysiology, The St Vincent's Hospital, Sydney, Australia.
Stephen
S
Tisch
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004576:Electromyography; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D049489:Stroboscopy; D014741:Video Recording; D014826:Vocal Cord Paralysis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014827:Vocal Cords / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult
Electromyography; Laryngeal electromyography; Laryngostroboscopy; Neurolaryngology; Vocal fold paralysis