Department of Otorhinolaryngology-Head and Neck Surgery, National University Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Kuala Lumpur 56000, Malaysia.
Department of Neurology and Internal Medicine, National University Malaysia Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, Batu 9 Cheras, Kuala Lumpur 56000, Malaysia.
Auris Nasus Larynx. 2021 Dec;48(6):1140-1149. doi: 10.1016/j.anl.2021.03.028. Epub 2021 Apr 23.
Laryngeal electromyography (LEMG) is used to confirm neuropathy; traditionally, it is evaluated qualitatively. This study aimed to develop normative values for the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex by determining the mean turns (MT) and mean amplitudes (MA) using the opposite normal mobile vocal fold in unilateral vocal fold paralysis (VFP). This study also compared the MT and MA of the paralyzed vocal fold with that of the normal side and analyzed their correlations.
This is a cross-sectional study in which 77 patients (18 males, 59 females, mean age of 48) with unilateral VFP with an opposite normal mobile vocal fold underwent LEMG with a standardized protocol. Koufman gradings and MT and MA were used for the qualitative and quantitative evaluations. Mann-Whitney U test was performed to compare the median of the turns and amplitudes between the opposite normal mobile vocal fold and the paralyzed side. A linear-scale graphical "cloud" of the normal TA-LCA muscle complex was generated using logarithmic regression analysis. The qualitative and quantitative parameters were analyzed using multiple analysis of variance and Kruskall-Wallis test. Post-hoc analysis was performed to further determine the differences of the significance between both parameters. The correlation between the qualitative and quantitative parameters was analyzed using Spearman correlation.
The MT and MA were significantly higher for the normal TA-LCA muscle complex than the paralyzed side (582 vs. 336; 412 vs. 296, respectively) and the median of the turns and amplitudes were significantly lower in the paralyzed side with p-values <0.001. A significant difference was observed between the Koufman grading and the combination of MT and MA [F (8,144) = 73.254] and between the Koufman grading and MT and MA individually [H (4, 72) = 18.3 and H (4, 72) =33.4], in which both had p-values <0.001. A moderate negative linear relationship was seen between the Koufman grading and MT and MA. On further analysis, it was revealed that only certain pairs of Koufman grading were statistical significant.
This study was the first to present the quantitative normative values and "cloud" of the TA-LCA muscle complex using the opposite normal mobile vocal fold in patients with unilateral VFP in which it is comparable to healthy controls. We concluded that quantitative LEMG supports the qualitative Koufman grading method however it cannot be used independently to determine the severity of neuropathy.
喉肌电图（LEMG）用于确认神经病变；传统上，它是定性评估的。本研究旨在通过确定单侧声带麻痹（VFP）中对侧正常活动声带的平均匝数（MT）和平均幅度（MA），为甲状腺-杓状软骨外侧-环杓侧肌复合体建立正常参考值。本研究还比较了麻痹声带与健侧声带的 MT 和 MA，并分析了它们之间的相关性。
这是一项横断面研究，共纳入 77 例单侧 VFP 患者（男性 18 例，女性 59 例，平均年龄 48 岁），这些患者均对侧声带可正常活动。所有患者均采用标准化方案进行 LEMG 检查。使用 Koufman 分级和 MT、MA 进行定性和定量评估。采用 Mann-Whitney U 检验比较对侧正常活动声带和麻痹侧声带的匝数和幅度中位数。采用对数回归分析生成正常 TA-LCA 肌复合体的线性图“云”。采用多因素方差分析和 Kruskal-Wallis 检验分析定性和定量参数。进一步采用多个方差分析和 Kruskal-Wallis 检验进行事后分析，以确定两个参数之间的显著性差异。采用 Spearman 相关分析对定性和定量参数之间的相关性进行分析。
正常 TA-LCA 肌复合体的 MT 和 MA 明显高于麻痹侧声带（分别为 582 对 336、412 对 296），麻痹侧声带的匝数和幅度中位数明显较低（p 值均<0.001）。Koufman 分级与 MT 和 MA 的组合[F（8,144）=73.254]以及与 MT 和 MA 单独比较均有显著差异[H（4,72）=18.3 和 H（4,72）=33.4]，p 值均<0.001。Koufman 分级与 MT 和 MA 之间存在中度负线性关系。进一步分析显示，只有某些 Koufman 分级之间有统计学差异。
本研究首次在单侧 VFP 患者中使用对侧正常活动声带呈现 TA-LCA 肌复合体的定量正常参考值和“云”，并与健康对照组进行了比较。我们得出结论，定量 LEMG 支持定性 Koufman 分级方法，但不能单独用于确定神经病变的严重程度。
