Department of Otolaryngology-Head & Neck Surgery, New York University School of Medicine, New York, New York, U.S.A.
Laryngoscope. 2013 Sep;123(9):2202-8. doi: 10.1002/lary.23950. Epub 2013 Jul 8.
OBJECTIVES/HYPOTHESIS: To describe a novel conduction study of the laryngeal nerves, including normal values and abnormal findings.
Prospective nonrandomized.
Seventeen healthy adult volunteers, as well as three patients with clinically identified laryngeal neuropathy, underwent low-level brief electrical stimulation of the laryngeal mucosa by means of a wire inserted via a transnasal flexible laryngoscope. Bilateral hookwire electrodes recorded the result in the laryngeal adductor muscles.
This study yields an early response ipsilateral to the side of stimulation (LR1), which is uniform and consistent (right = 13.2 ± 0.80 msec; left = 15.2 ± 1.20 msec), and late bilateral responses (ipsilateral LR2 [LR2i] and contralateral LR2 [LR2c]), which exhibit greater variation in latency and morphology (right LR2i = 50.5 ± 3.38 msec; left LR2i = 52.2 msec; right LR2c = 50.7 ± 4.26; left LR2c = 50.6 ± 4.07). Findings in abnormal patients differ significantly from normal, consistent with the distribution of neuropathy.
We describe a novel, clinically applicable conduction study of laryngeal nerves. Normative electrodiagnostic values and variations of the reflex responses of the laryngeal adductor muscles in response to irritative stimulation of the laryngeal mucosa (Laryngeal Closure Reflex) are proposed. By enabling the determination of electrophysiological parameters of the superior laryngeal and recurrent laryngeal branches of cranial nerve X (CN X), this procedure, which is used as an adjunct to laryngeal electromyography, may provide earlier and more accurate information regarding the extent and grade of nerve injury. Because injury grade relates directly to prognosis, the information derived from this test may have clinical relevance in determining optimal treatment.
目的/假设：描述一种新的喉神经传导研究，包括正常值和异常发现。
前瞻性非随机。
17 名健康成年志愿者，以及 3 名临床诊断为喉神经病的患者，通过经鼻软喉镜插入的金属丝进行低水平短暂的喉黏膜电刺激。双侧钩线电极记录喉内收肌的结果。
本研究产生了同侧刺激（LR1）的早期反应，其均匀且一致（右侧=13.2±0.80 msec；左侧=15.2±1.20 msec），以及双侧晚期反应（同侧 LR2[LR2i]和对侧 LR2[LR2c]），其潜伏期和形态表现出更大的变化（右侧 LR2i=50.5±3.38 msec；左侧 LR2i=52.2 msec；右侧 LR2c=50.7±4.26；左侧 LR2c=50.6±4.07）。异常患者的发现与正常患者明显不同，与神经病的分布一致。
我们描述了一种新的、临床适用的喉神经传导研究。提出了正常的电诊断值和喉内收肌对喉黏膜刺激性刺激（喉闭合反射）的反射反应的变化。通过确定颅神经 X（CN X）的上喉和返喉分支的电生理参数，该程序可作为喉肌电图的辅助手段，为神经损伤的程度和等级提供更早和更准确的信息。由于损伤等级与预后直接相关，该测试获得的信息可能在确定最佳治疗方案方面具有临床意义。
