The diagnostic value of laryngeal electromyography in vocal fold paralysis and arytenoid dislocation / 临床耳鼻咽喉头颈外科杂志

OBJECTIVES@#To identify diagnostic value of laryngeal electromyography (LEMG) in differentiating vocal fold paralysis (VFP) from arytenoid dislocation.@*METHODS@#The history, laryngeal morphologic characteristics and LEMG of 36 patients with VFP and 10 patients with arytenoid dislocation were compared and analyzed.@*RESULTS@#The most common cause of 36 VFP patients was surgical damage (24 cases), and the most common cause of 10 arytenoid dislocation patients was history of endotracheal intubation (9 cases). There was no statistical difference between the vocal fold and the fixed position of the vocal fold between the group of VFP patients and arytenoid dislocation patients. In the patients with VFP, 33 VFP patients (91.67%) had decreased recruitment; 9 cases (9/13) of denervation potential and 8 cases (8/9) of regeneration potential occurred within 1-6 months of the course of disease; 3 cases (3/4) of synkinesis occurred in the course of disease more than 6 months. In the patients with VFP, the amplitude (<0.01) and turns (<0.05) of thyroarytenoid muscles significantly decreased in the lesioned side comparing to the normal one, but the turns/amplitude ratio showed no statistical difference. In the patients with superior laryngeal nerve injury, the turns and amplitude analysis of cricothyroid muscles showed no statistical difference. All of 10 patients with arytenoid dislocation showed normal LEMG patterns.@*CONCLUSIONS@#LEMG can be used to differentiate the patients with vocal cord paralysis from arthrodesis dislocation, and can also carry out quantitative analysis to provide valuable help for the diagnosis.

The Clinical Characteristics of Unilateral Vocal Fold Paralysis and Arytenoid Dislocation / 听力学及言语疾病杂志

Objective To investigate the value of clinical characteristics in diagnosis of vocal fold paralysis (VFP) and arytenoid dislocation .Methods Eighty - eight patients of VFP and 27 patients of arytenoid dislocation were studied , by comparing the causes , laryngeal morphologic characteristics and laryngeal electromyography (LEMG) .Results The causes of 88 VFP patients included surgery (45 cases) ,neck trauma(2 cases) ,idiopathic causes(16 cases) ,infection(16 cases) ,and tumor invasion - related(9 cases) .Of the 27 arytenoid dislocation pa‐tients ,24 had a history of endotracheal intubation and the others had a history of gastric tube insertion .The vocal folds were mostly fixed at the paramedian position ,followed by the abducent position and the median position .No significant differences were found in laryngeal morphologic characteristics between the two groups ,including vocal fold shape , glottis vertical symmetry , mucosal waves , supraglottic compensation , glottis closure and arytenoid movement .The LEMG of VFP patients appeared as denervation patterns ,reinnervation potentials ,or electrical si‐lence ;the recruitment patterns appeared as mix or simple patterns ;the evoked potentials were absent .Of the VFP patients ,54 cases(61 .36% % )were found synkinesis of involved posterior cricoarytenoid and two of them also in ‐volved thyroatenoid .The patients with synkinesis had lower percentage of vocal fold bowing and higher percentage of glottic vertical asymmetry compared to the ones without synkinesis .Of the VFP patients whose cause was surgery or neck trauma ,the median - position fixed vocal folds were mostly observed in the patients with duration of less than 1 month or with synkinesis .Of the 27 arytenoid dislocation patients ,20(74 .07% )showed normal LEMG pat‐terns and 7(25 .93% )showed apparent LEMG abnormality on the affected side .Conclusion The causes of vocal fold paralysis and arytenoid dislocation are different .Laryngeal morphologic characteristics have limitations in distinguis‐hing vocal fold paralysis from arytenoid dislocation .The shape and position of involved vocal folds of the VFP pa‐tients are correlated with duration ,nerve regeneration and synkinesis .

A Preliminary Study of Laryngeal Electromyography for Evaluating Swallowing Function of Patients with Amyotrophic Lateral Sclerosis / 听力学及言语疾病杂志

Objective To investigate the clinical values of laryngeal electromyography (LEMG) for evaluating the amyotrophic lateral sclerosis(ALS) patients with swallowing disorder .Methods A total of 25 ALS patients with or without complaining of swallowing disorder were recruited for the study .Their right cricothyroid muscles were taken unilaterally with concentric needle electrodes by anterior cervical approach .Each patient was tested with Kub-ota drinking test too .Results Of all the 25 patients ,11 were found abnormal in the right cricothyroid muscle which presented with typical degeneration patterns ,15 cases were found abnormal by Kubota drinking test .The coinci-dence rate of the two methods was 60% ,the poisitive coincidence rate was 32% .The McNemar test showed there was some consistency between the drinking water test and LEMG (P=0 .344) ,and the Kappa coefficient was 0 .219 . Conclusion The cricothyroid muscle electromyography may also be a potential method to evaluate ALS patients since it seemed to offer an evidence of dysphagia related with abnormal sensory function of laryngeal mucosa .But there may be some limitations .

Secondary Achalasia due to Injury of Vagus Nerve after Chest Trauma: A case report

Achalasia is rare disorder with an estimated prevalence of 0.5~1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma.

Clinical Usefulness of Laryngeal Electromyography for Patients with Vocal Cord Palsy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVE: Vocal cord palsy is a complex disorder which may result from numerous causes. Laryngeal electromyography is a valuable adjunct in the study of vocal cord dysfunction. It yields objective and reproducible data, and may establish the pathophysiology and prognosis of laryngeal nerve pathology. We investigated the clinical usefullness of laryngeal electromyography for patients with vocal cord palsy. MATERIAL & METHOD: Laryngeal EMG was performed for 35 patients diagnosed as vocal cord palsy. RESULTS: We defined complete denervation when electrical silence, fibrillation potential or positive sharp waves were seen. We defined partial denervation when motor unit potential with low amplitude and low frequency was seen. We planned treatment modality according to the laryngeal EMG findings. In case of complete denervation, phonosurgery was recommended, whereas voice therapy and observation were recommended when partial denervation was noted. CONCLUSION: Laryngeal EMG is clinically valuable for the evaluation of vocal cord palsy and can serve as a guideline for determining the treatment plan. It is also useful in anticipating the prognosis of laryngeal nerve palsy.

A Case of Cricoarytenoid Joint Dislocation due to Blunt Trauma to the Larynx / 대한이비인후과학회지

Cricoarytenoid joint dislocation is not an uncommon complication resulting from intubation trauma or blunt trauma to the neck, yet it has been poorly documented. Hoarseness is the most prevalent symptom, and poor mobility of the vocal fold is the most common sign. It is best evaluated by stroboscopic examination combined with laryngeal electromyography(EMG). Early diagnosis is important for appropriate surgical management and better prognosis. Closed reduction of dislocated joint is the treatment of choice. A case of cricoarytenoid joint dislocation after blunt trauma to the anterior neck is presented with a brief review of literature.