HSC Section 6 Nov2016 Green Book

Croake et al

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The University of Kentucky College of Health Sciences Office of Research supported this project through pilot funding. References 1. Sataloff RT, Mandel S, Mann EA, Ludlow CL. Practice parameter: laryngeal electromyography (an evidence-based review). J Voice . 2004;18(2):261-274. 2. Ludlow CL, Yeh J, Cohen LG, Van Pelt F, Rhew K, Hallett M. Limitations of electromyography and magnetic stimula- tion for assessing laryngeal muscle control. Ann Otol Rhinol Laryngol . 1994;103(1):16-27. 3. Woo P. Laryngeal electromyography is a cost-effective clini- cally useful tool in the evaluation of vocal fold function. Arch Otolaryngol Head Neck Surg . 1998;124(4):472-475. 4. Heman-Ackah YD, Mandel S, Manon-Espaillat R, Abaza MM, Sataloff RT. Laryngeal electromyography. Otolaryngol Clin North Am . 2007;40(5):1003-1023. 5. Sataloff R, Mandel S, Heman-Ackah Y, Manon-Espaillat R, Abaza M. Laryngeal Electromyography . 2nd ed. San Diego, CA: Plural Publishing; 2006. 6. Basmajian J. Muscles Alive: Their Functions Revealed by Electromyography . 3rd ed. Baltimore, MD: Williams and Wilkins Company; 1974. 7. Hillel AD. The study of laryngeal muscle activity in nor- mal human subjects and in patients with laryngeal dystonia using multiple fine-wire electromyography. Laryngoscope . 2001;111(4 Pt 2 Suppl 97):1-47. 8. Blitzer A, Crumley RL, Dailey SH, et al. Recommendations of the Neurolaryngology Study Group on laryngeal elec- tromyography. Otolaryngol Head Neck Surg . 2009;140(6): 782-793.e786. 9. Koufman JA, Postma GN, Whang CS, et al. Diagnostic laryngeal electromyography: The Wake Forest experience 1995-1999. Otolaryngol Head Neck Surg . 2001;124(6): 603-606. 10. Sittel C, Stennert E, Thumfart WF, Dapunt U, Eckel HE. Prognostic value of laryngeal electromyography in vocal fold paralysis. Arch Otolaryngol Head Neck Surg . 2001;127(2):155-160. 11. Basmajian J, De Luca C. Muscles Alive: Their Functions Revealed by Electromyography . 5th ed. Baltimore, MD: Williams & Wilkins; 1985. 12. De Luca CJ. Surface Electromyography: Detection and Recording . Natick, MA: Delsys Inc.; 2002. http://www.del- sys.com/Attachments_pdf/WP_SEMGintro.pdf. Accessed November 2008. 13. Bamman MM, Ingram SG, Caruso JF, Greenisen MC. Evaluation of surface electromyography during maximal

significantly variable across testing sessions. It is reasonable to expect greater variability in an office setting without these control parameters. Laryngeal electromyography holds much potential to be a useful clinical tool available for diagnosing movement disorders of the larynx. To obtain the maximum benefit from clinical LEMG, a universal standardized proto- col that is feasible within a typical in-office setting should be developed. Further prospective research studies should con- sider the evaluation of (1) hooked wire electrode use for con- tralateral comparisons and (2) vocal frequency and intensity controls to regulate muscle recruitment to maximize the interpretability of LEMG measures. Quantitative LEMG techniques that may be used for clinical application are now feasible and relatively inexpensive and should be explored. Laryngeal electromyography follow-up diagnostics would also be useful for data comparisons. A recent article by Sataloff et al stated that follow-up LEMG is not performed in up to 90% of cases if visual inspection of the larynx demon- strates improved vocal fold mobility. 29 Follow-up testing could provide useful reliability data for LEMG as performed in the clinic. Data from this study offer insight into the importance of using loading controls (control of intensity and fre- quency) in order to obtain the most accurate data from clinical LEMG. Methodologically, the use of hooked wire LEMG may be a good alternative to needle electrodes for several reasons, including freeing the clinician to direct the patient to control pitch and loudness levels, allowing for simultaneous measures, and reducing the possibility of artifact from needle electrode movement. With today’s technology, control of vocal frequency and intensity can be easily accomplished through visual feedback to the patient using an inexpensive headset microphone con- nected to a laptop computer or other mobile device run- ning commercially available sound intensity applications. In addition, quantitative signal processing tools are becoming more accessible and less expensive, allowing for the real-time use of quantitative techniques such as RMS to improve the quality of in-office assessments and the use of rise-time functions to confirm optimal elec- trode placement. 30 In closing, LEMG is a clinical assessment tool that has not yet reached its full potential. The means to make LEMG a more quantitative and reliable assessment method are available and ready for usage to improve the clinical reli- ability and usefulness of this potentially important diagnos- tic method. Acknowledgments The authors would like to thank the participants for undergoing multiple LEMG procedures for this study, and the University of Kentucky College of Health Sciences Office of Research for sup- porting this project through pilot funding.

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