Larygeal EMG

[RUOkie]

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I was approached by an ENT friend who asked me about laryngeal EMG. He has a woman with bilateral vocal cord paralysis after a thyroid surgery (now with a trach) who he thinks will need it for prognosis.

I discussed with him that he could do the needle stick, and I would do the waveform analysis (since he could insert the needle while under direct laryngoscopy).

Anybody ever do this?

 

[Tap0utt]

ive seen the neuromuscular doc do just as you said. the ent does the anesthesizing and insertion while the neurogist guides him in terms of distance vs incorrect muscle placement vs correct placement.

 

[nvrsumr]

I did a few of these as a resident but without ENT or laryngoscope. Not super difficult but then again I wasnt ultimately responsible. Looks like a lecture on the topic is being given at the AANEM meeting.

 

[Bombesin]

I did a few of these as a resident but without ENT or laryngoscope. Not super difficult but then again I wasnt ultimately responsible. Looks like a lecture on the topic is being given at the AANEM meeting.

The lecturer is actually one of the PM&R physicians here at UPMC that performs these on a regular basis in conjunction with ENT.

 

[pmr4life]

Inquiring mind wishes to know: what prognostic information do you obtain from vocal cord EMG's? Here's my line of thought....Stick the muscle, if there's motor units, then there likely will be enough peripheral sprouting to gain functional strength. If there's no units, then complete denervation, poor prognosis. In this case you already have an etiology from the surgery (unless diagnostically, you think this is not denervation and that's what you're trying to prove). And if you get no motor units, do the surgeons like to head in the jungle to reconnect/graft the recurrent laryng. nerve? If not, then it's all conservative management, and is there a good reason to do the EMG at all? I'm curious....because if our institution does it, I just don't about it.

Thanks!

 

[RUOkie]

Inquiring mind wishes to know: what prognostic information do you obtain from vocal cord EMG's? Here's my line of thought....Stick the muscle, if there's motor units, then there likely will be enough peripheral sprouting to gain functional strength. If there's no units, then complete denervation, poor prognosis. In this case you already have an etiology from the surgery (unless diagnostically, you think this is not denervation and that's what you're trying to prove). And if you get no motor units, do the surgeons like to head in the jungle to reconnect/graft the recurrent laryng. nerve? If not, then it's all conservative management, and is there a good reason to do the EMG at all? I'm curious....because if our institution does it, I just don't about it.

Thanks!

it would be done for prognostic reasons only. The ENT wanted the information for academic purposes only. And the point was moot. The lady has no-showed to her last 2 visits with the surgeon anyway.

 

[lobelsteve]

We did it 2 mornings per month for ENT clinic. They did Botox for spasmodic dysphonia and we did the EMG guidance. Boring.