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Neurophysiological Assessment in Children with Vocal Fold Paralysis: A Tertiary Center Experience
Roberto D'Agostino1, Tommaso Cacco1, Ivana Fiz1
1Otorhinolaryngology Unit, IRCCS Institute G. Gaslini, Genoa, Italy.
Insights
This study assessed pediatric vocal fold paralysis using corticobulbar motor-evoked potentials (Co-MEPs) and laryngeal electromyography (L-EMG). Findings correlate patient characteristics with electrophysiological results, aiding in understanding VFP in children.
Area of Science:
- Pediatric Neurology
- Otolaryngology
- Neurophysiology
Background:
- Vocal fold paralysis (VFP) in children presents unique diagnostic challenges.
- Electrophysiological assessments are crucial for evaluating nerve integrity in VFP.
- Understanding the correlation between patient factors and electrophysiological findings is vital for management.
Purpose of the Study:
- To evaluate the utility of laryngeal electrophysiological assessment using Co-MEPs and L-EMG in pediatric VFP.
- To correlate electrophysiological findings with patient characteristics, comorbidities, and VFP etiology.
- To report on acquired experience with these techniques in pediatric VFP cases.
Main Methods:
- Pediatric patients with suspected or diagnosed VFP underwent electrophysiological recordings under general anesthesia.
- Corticobulbar motor-evoked potentials (Co-MEPs) were recorded.
- Laryngeal electromyography (L-EMG) of thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles was performed.
Main Results:
- Early gestational age correlated significantly with TA and PCA muscle intensity.
- Tracheostomy presence showed significant correlation with TA and PCA muscle intensity.
- Genetic anomalies were associated with TA and PCA muscle intensity and latency.
- Congenital VFP presentation correlated with increased TA muscle intensity and latency.
- TA and PCA muscle intensities were significantly correlated.
Conclusions:
- Intraoperative Co-MEPs and L-EMG are complementary tools for assessing the motor pathway to TA and PCA muscles in pediatric VFP.
- These electrophysiological methods help evaluate the functional integrity of the neural structures involved in VFP.
- Further research is needed to determine the predictive value of these assessments for vocal fold mobility recovery and potential decannulation.
Objective:
The aim of this study is to report on experience acquired during the laryngeal electrophysiological assessment with Co-MEP and L-EMG in pediatric patients with acquired, congenital, and syndromic vocal fold paralysis (VFP), and correlate our findings with patients' characteristics, their comorbidities, and VFP etiology.
Methods:
Pediatric patients with suspected or previously diagnosed unilateral or bilateral VFP underwent electrophysiological records under general anesthesia; corticobulbar motor-evoked potentials (Co-MEPs) and laryngeal electromyography (L-EMG) of thyroarytenoid (TA) and posterior cricoarytenoid (PCA) muscles were recorded.
Results:
Statistical analysis revealed a statistically significant correlation between early gestational age at childbirth and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); tracheostomy presence and TA muscle intensity (p = 0.002) and PCA muscle intensity (p = 0.002); presence of genetic anomalies with intensity and latency for TA muscle and latency for PCA muscle (TA latency p = 0.015, TA intensity p = 0.021, PCA latency p = 0.035); congenital presentation of VFP and an increased intensity for TA muscle (p = 0.04); latency and intensity for TA muscle (p = 0.024); TA muscle intensity and PCA intensity (p = 0.005).
Conclusion:
Intraoperative Co-MEPs and L-EMG are two complementary tools for evaluating the functional integrity of the structures involved in conveying signals from the motor cortex to TA and PCA muscles in children with vocal fold paralysis. Further studies are needed to establish their ability to predict the recovery of VF mobility, which could potentially lead to decannulation.
Level Of Evidence:
4 Laryngoscope, 135:935-941, 2025.
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