ELECTROMYOGRAPHY IN NEAR-TOTAL LARYNGECTOMY

Objective: To investigate the dynamics of speech shunt muscle in patie nts with Pearson near-total laryngectomy by needle electromyography an d correlation of ability to activate shunt muscle with speech producti on. Design and Settings: Prospective study of patients with near-total laryngectomy at 2 hospital-based academic tertiary care centers. Part icipants and Intervention: Fourteen patients with near-total laryngect omy were subjected to percutaneous needle electromyographic study of t he shunt muscle. Main Outcome Measures: Speech ability, electromyograp hic evidence of viable muscle in shunt wall, and ability to activate s hunt muscle were recorded. Results: Twelve of 14 patients had good spe ech; 11 had evidence of viable shunt muscle; and 9 were able to activa te muscle by phonation, swallowing, or deep breathing, indicating pres erved innervation. Six of the 12 patients with speech ability and 1 of the 2 patients without speech ability were able to recruit motor unit s during attempted phonation. Conclusions: Electromyography demonstrat ed viable muscle with retained innervation in 64% of the patients with near-total laryngectomy, proving its ''dynamic'' nature. However, the usefulness of shunt muscle activation in speech and prevention of asp iration needs further confirmation.