Lack of evoked laryngeal electromyography response in patients with a clinical diagnosis of vocal cord paralysis

There has been recent debate about whether patients with vocal cord immobil ity have a neurologic paralysis or whether synkinesis, the misdirection of axons to competing laryngeal muscles, is responsible for the lack of volunt ary vocal cord motion. This issue was studied in 15 patients with vocal cor d paralysis who underwent laryngeal reinnervation. Evoked electromyography was performed with a surface electrode endotracheal tube. The recurrent lar yngeal nerve (RLN) was identified and stimulated with constant current. Of the 15 patients, only 1 produced a compound muscle action potential upon ne rve stimulation. The remaining 14 patients had no evoked response during RL N stimulation. A control group of 8 patients with normal vocal cord mobilit y was studied, and each had a normal evoked electromyography response after RLN stimulation. These results support the assertion that patients who req uire treatment for vocal cord paralysis do not have synkinesis produced by RLN reinnervation.