Acta Otorrinolaringol Esp. 2018;69(4):231---242 www.elsevier.es/otorrino REVIEW ARTICLE Recommendations on the Use of Neuromonitoring in Thyroid and Parathyroid Surgery  José Luis Pardal-Refoyo, a,b,* Pablo Parente-Arias, a,c Marta María Arroyo-Domingo, a,d Juan Manuel Maza-Solano, a,e José Granell-Navarro, a,f Jesús María Martínez-Salazar, g Ramón Moreno-Luna, a,e Elvylins Vargas-Yglesias a,h a Comisión de Cabeza y Cuello y Base de Cráneo (SEORL CCC), Spain b SACYL.Complejo Asistencial de Zamora, Zamora, Spain c Complexo Hospitalario Universitario de A Coru˜ na, A Coru˜ na, Spain d Hospital de Torrevieja, Alicante, Spain e Hospital Universitario Virgen Macarena, Sevilla, Spain f Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain g Hospital Universitario del Sureste, Arganda del Rey, Madrid, Spain h Hospital Universitario de Móstoles, Móstoles, Madrid, Spain Received 4 June 2017; accepted 15 June 2017 KEYWORDS Thyroidectomy; Parathyroidectomy; Neuromonitoring; Recurrent laryngeal nerve; Electromyography; Patient safety; Guidelines; Larynx; Voice; Thyroid; Parathyroid Abstract Introduction: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neu- romonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most contro- versial aspects are necessary. Objective: To develop a support document for guidance on the use of IONM in TPTS. Method: Work group consensus through systematic review and the Delphi method. Results: Seven sections were identified on which points of consensus were identified: indica- tions, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. Conclusions: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral  Please cite this article as: Pardal-Refoyo JL, Parente-Arias P, Arroyo-Domingo MM, Maza-Solano JM, Granell-Navarro J, Martínez-Salazar JM, et al. Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides. Acta Otorrinolaringol Esp. 2018;69:231---242. ∗ Corresponding author. E-mail address: jlpardal@usal.es (J.L. Pardal-Refoyo). 2173-5735/© 2017 Sociedad Espa˜ nola de Otorrinolaringolog´ ıa y Cirug´ ıa de Cabeza y Cuello. Published by Elsevier Espa˜ na, S.L.U. All rights reserved.