Using Quantitative Laryngeal Electromyography to Predict Vocal Fold Position and Functional Outcomes in Patients of Unilateral Recurrent Laryngeal Nerve Paralysis and the Change of Neuromuscular Control after Early Temporary Intracordal Injection

  • Fang, Tuan-Jen (PI)
  • Li, Hsueh-Yu (CoPI)
  • Pei, Yu-Cheng (CoPI)

Project: National Science and Technology CouncilNational Science and Technology Council Academic Grants

Project Details

Abstract

Background: The function of muscle corresponds to the neuromuscular control, which can be measured by electromyography (EMG). At present, laryngeal EMG is a qualitative examination when establishing whether motor unit recruitment is normal or abnormal. Thus the report of tone and function of intrinsic laryngeal muscle was limited. Vocal cord position in patients with unilateral recurrent laryngeal nerve paralysis may change over time. Vocal cord position has been shown to correlate with patients’voice and swallowing outcomes. Recent studies revealed that early administration of temporary intracordal injection would influence long-term vocal position and vocal function, a finding that supports the efficacy of early injection but, however, its mechanism was unclear. Some suggested mechanical medializing force by temporary substances and following fibrosis fixed the cord in median position while others suggest that vibro-tactile stimulation induced by contacting the contralateral mobile cord reduces misrouting axons while regenerating and thus improves the outcome. It is thus of utmost interest to investigate the relationship among acting motor potential, vocal cord position and vocal function. Interference pattern analysis for quantitative laryngeal electromyography data (denoted as Q-LEMG) is a novel methodology that provides a reliable measurement of the level of motor unit recruitment. In our preliminary data, interference level computed by Q-LEMG positively correlates with Voice Outcome Survey scores, a novel observation supporting the hypothesis that voice impairment is predominately determined by the level of remaining neuronal motor inputs. Thus, the determinants of vocal cord position change remain unclear. Purposes: 1. Evaluate the correlation of EMG activity of intrinsic laryngeal muscle and vocal cord position and its impaction on vocal functions. 2. To search for the predictors of vocal fold position in paralyzed larynx by Q-LEMG. 3. Detect the differences of recruitment between early hyaluronic acid injection and observation group and clarify the mechanism of temporary intracordal injection. Study designs: The present four-year project will enroll 120 patients with unilateral recurrent laryngeal nerve paralysis. According to the interval from the onset of injury and time of therapy, patients will be divided into 3 groups: Group A includes 40 patients that had damage over 12 months, group B 40 cases of acute RLN injury who accept a conventional observation policy of therapy and group C 40 acute RLN injury patients that will undergo hyaluronan intracordal injection within six-month from RLN damage. At every follow-up, we will obtain the Q-LEMG data, vocal cord position, voice laboratory data and quality of life. Predictive outcomes: 1. Confirm the predicting roles of recruitment ratio and interference pattern measured by Q-LEMG on the change of paralyzed vocal cord position. 2. Achieve the correlation of the neuromuscular control of intrinsic laryngeal muscle and vocal fold position. 3. Analyze the impaction of early temporary injection on long term neuromuscular control in intrinsic laryngeal muscle.

Project IDs

Project ID:PC10107-0347
External Project ID:NSC101-2314-B182A-106
StatusFinished
Effective start/end date01/08/1231/07/13

Keywords

  • quantitative laryngeal electromyography
  • recurrent laryngeal nerve paralysis
  • muscle tone
  • laryngeal electromyography
  • injection laryngoplasty
  • outcomes measurement

Fingerprint

Explore the research topics touched on by this project. These labels are generated based on the underlying awards/grants. Together they form a unique fingerprint.