Intraoperative laryngeal electromyography in children with vocal fold immobility: A simplified technique Andrew R. Scott a , Peter Siao Tick Chong b , Gregory W. Randolph a , Christopher J. Hartnick a, * a Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, United States b Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States Received 6 July 2007; received in revised form 11 September 2007; accepted 14 September 2007 Available online 19 November 2007 International Journal of Pediatric Otorhinolaryngology (2008) 72, 31—40 www.elsevier.com/locate/ijporl KEYWORDS Vocal fold paralysis; Laryngeal electromyography; Dysphonia; Aspiration; Stridor; Children Summary Objectives: The primary objective of this study was to determine whether a simplified technique for intraoperative laryngeal electromyography was feasible using standard nerve integrity monitoring electrodes and audiovisual digital recording equipment. Our secondary objective was to determine if laryngeal electromyography data provided any additional information that significantly influenced patient management. Methods: Between February 2006 and February 2007, 10 children referred to our institution with vocal fold immobility underwent intraoperative laryngeal electromyo- graphy of the thyroarytenoid muscles. A retrospective chart review of these 10 patients was performed after institutional review board approval. Results: Standard nerve integrity monitoring electrodes can be used to perform intraoperative laryngeal electromyography of the thyroarytenoid muscles in children. In 5 of 10 cases reviewed, data from laryngeal electromyography recordings mean- ingfully influenced the care of children with vocal fold immobility and affected clinical decision-making, sometimes altering management strategies. In the remaining 5 children, data supported clinical impressions but did not alter treatment plans. Two children with idiopathic bilateral vocal fold paralysis initially presented with a lack of electrical activity on one or both sides but went on to develop motor unit action potentials that preceded recovery of motion in both vocal folds. Conclusions: Our findings suggest that standard nerve monitoring equipment can be used to perform intraoperative laryngeal electromyography and that electromyo- * Corresponding author. E-mail address: christopher_hartnick@meei.harvard.edu (C.J. Hartnick). 0165-5876/$ — see front matter # 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2007.09.011