The George Washington University Medical Center, Washington, DC 20037, USA.
J Speech Lang Hear Res. 2010 Feb;53(1):100-13. doi: 10.1044/1092-4388(2009/08-0244). Epub 2009 Nov 30.
Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from previous studies with presbylarynges and significantly different from those of patients with abnormal LEMG.
A retrospective chart review of acoustic, aerodynamic, endoscopic, and self-rating measures was completed for 52 individuals over 64 years of age reporting moderate to severe hoarseness.
Individuals with normal LEMG had measures similar to those of patients from previous studies diagnosed with presbylarynges. The group with LEMG abnormalities was subcategorized by specific nerve(s) affected. Significant differences were found for measures between presbylarynges and unilateral but not bilateral paresis groups. Several endoscopic findings were observed more often than expected in the presbylarynges group. Using electromyography as a gold standard, the presence of any impairment in arytenoid movement had the most sensitivity (77%) in making the diagnosis of paresis, and the absence of any impairment had the most specificity (67%) in making the diagnosis of presbylarynges.
LEMG may be useful in differentially diagnosing hoarseness in older patients, especially to distinguish between bilateral paresis and presbylarynges.
对 64 岁以上报告声音嘶哑的患者进行鉴别诊断具有挑战性。喉肌电图（LEMG）用于确定喉返神经和喉上神经的状态。作者假设，声音嘶哑但 LEMG 正常的个体的测量值与以前研究中具有 presbylarynges 的患者的测量值相似，与 LEMG 异常的患者的测量值显著不同。
对 52 名 64 岁以上报告中度至重度声音嘶哑的患者进行了声学、气动、内窥镜和自我评估测量的回顾性图表审查。
LEMG 正常的个体的测量值与以前研究中诊断为 presbylarynges 的患者的测量值相似。LEMG 异常的组根据受影响的特定神经进行了细分。在 presbylarynges 和单侧但非双侧弛缓组之间发现了测量值的显著差异。在 presbylarynges 组中观察到几种内窥镜发现的频率高于预期。使用肌电图作为金标准，在诊断弛缓症时，任何杓状软骨运动障碍的存在具有最高的敏感性（77%），而在诊断 presbylarynges 时，任何无损伤的存在具有最高的特异性（67%）。
LEMG 可能有助于对老年患者的声音嘶哑进行鉴别诊断，特别是区分双侧弛缓和 presbylarynges。
