Objectives: Despite the belief that it represents a central neurologic dysfunctional process, adductor-type spasmodic dysphonia without tremor is usually effectively treated by injection of botulinum toxin A; however, in most cases such injections must be repeated every few months. A promising new surgical procedure is herein reported. Methods: Under local anesthesia with intravenous sedation, a large laryngoplasty window is created, and under direct vision with intraoperative voice monitoring, fibers from the thyroarytenoid and lateral cricoarytenoid muscles are removed until breathiness occurs. The two sides are staged; that is, one side is done at a time, with surgery on the second side being performed 3 to 6 months after that on the first side, if needed. Results: This was a retrospective, unblinded study of 5 patients who underwent myectomy of the thyroarytenoid and lateral cricoarytenoid muscles. The preliminary results show improved voice fluency in all patients at 5 to 19 months of follow-up. There was no period of prolonged breathiness or dysphagia in any of the patients, and there were no surgical complications. Conclusions: Myectomy of the thyroarytenoid and lateral cricoarytenoid muscles is a promising new surgical treatment for adductor-type spasmodic dysphonia that may effectively mimic “permanent” botulinum toxin injections.

Background High-resolution transnasal esophagoscopy (TNE) allows comprehensive, in-office examination of the esophagus without sedation. Objective. To compare the authors' present experience using TNE with our initial, previously reported experience. Methodology: Retrospective review of 611 consecutive patients undergoing TNE was compared with 100 consecutive patients previously reported. Results: The most frequent indications for TNE were screening examination of the esophagus in reflux, globus, or dysphagia patients (n = 490), biopsy of a lesion in the laryngopharynx, trachea, or esophagus (n = 42), screening examination of the esophagus in head and neck cancer patients (n = 45), and evaluation for an esophageal foreign body (n = 12). Seventeen procedures were aborted secondary to a tight nasal vault. Significant findings were found in 50% (2941592). The most frequent findings were esophagitis (n = 98), hiatal hernia (n = 47), and Barrett's esophagus (n = 27). These results are similar to those previously reported. Conclusions. TNE is safe, well tolerated by patients, and is easy to learn with a short learning curve. TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.

BACKGROUND:Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for Voice Disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid hypertelorism caused by cricoid chondrosarcoma may be aphonic even though the anterior membranous vocal folds make contact during attempted phonation. METHODS:Between 1991 and 2002, nine patients were diagnosed with cricoid chondrosarcoma. Patients' charts and video examinations were retrospectively evaluated for symptoms and the presence of arytenoid hypertelorism on endoscopic evaluation. Two were women, and seven were men, with a mean age of 70 (range 53-72) years at diagnosis. RESULTS:Eight (88%) patients had aphonia or dysphonia caused by arytenoid hypertelorism as their presenting symptom. Six were diagnosed after failed medialization laryngoplasty or other laryngeal rehabilitation surgery. All nine patients had a low-grade tumor. The initial treatment in eight patients was hemicricoidectomy, and one patient had a total laryngectomy. In four cases, a second procedure was needed 1 to 6 years later because of recurrence. Seven patients are alive without clinically significant disease; one is alive with moderate disease, and one has died from an unrelated cause. CONCLUSIONS:Severely dysphonic, elderly patients presenting with arytenoid hypertelorism of unknown cause should be evaluated by fiberoptic laryngoscopy and by computed tomography scan to rule out cricoid chondrosarcoma. Because these tumors behave so benignly, the authors recommend conservative surgery (unilateral hemicricoidectomy) as the diagnostic/treatment modality of choice.

BACKGROUND: Laryngopharyngeal reflux (LPR) disease arises from the effects of refluxed gastric contents on the proximal aerodigestive tract. LPR patients are often lumped into the category of "atypical" reflux. LPR symptoms are hoarseness, globus, cough, and pharyngitis. Severe disease is associated with subglottic stenosis and laryngeal cancer. Treatment includes lifestyle modifications and medications. The role of fundoplication for LPR has yet to be defined.STUDY DESIGN: Forty-one patients underwent fundoplication for LPR. They were prospectively followed with three outcomes measures: The Reflux Symptom Index, a laryngoscopic grading scale (Reflux Finding Score), and a reflux-based specific quality-of-life scale.RESULTS: Average early followup was at 4 months and late followup was at 14 months. The Reflux Symptom Index improved by 5.4 early (p < 0.05) and 6.5 late (p < 0.05). Improvement between early and late periods approached significance (p < 0.09). Reflux Finding Score improved 3.8 (p < 0.05) early and 4.4 (p < 0.05) late. The Quality of Life Index improved 0.6 early and 2.3 (p < 0.05) late. By Reflux Symptom Index criteria, 26 patients were improved early versus 35 late (p < 0.05). Factors associated with poor outcomes were structural laryngeal changes in five patients (p < 0.05) and no response to proton pump inhibitors in six patients (p < 0.05).CONCLUSIONS: Fundoplication augments treatment of LPR. Improvement of symptoms continues past the first 4 months. Laryngoscopy is critical in patient selection because selected findings are associated with outcomes, diagnosis, and management. (C) 2004 by the American College of Surgeons.

The LaryngoscopeVolume 113, Issue 1 p. 173-176 Article In-Office Tracheoesophageal Puncture Using Transnasal Esophagoscopy Kevin K. Bach MD, Kevin K. Bach MD Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Search for more papers by this authorGregory N. Postma MD, Corresponding Author Gregory N. Postma MD [email protected] Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Gregory N. Postma, MD, Center for Voice Disorders of Wake Forest University, Department of Otolaryngology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1034, U.S.A.Search for more papers by this authorJames A. Koufman MD, James A. Koufman MD Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Search for more papers by this author Kevin K. Bach MD, Kevin K. Bach MD Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Search for more papers by this authorGregory N. Postma MD, Corresponding Author Gregory N. Postma MD [email protected] Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Gregory N. Postma, MD, Center for Voice Disorders of Wake Forest University, Department of Otolaryngology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157-1034, U.S.A.Search for more papers by this authorJames A. Koufman MD, James A. Koufman MD Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina, U.S.A.Search for more papers by this author First published: 02 January 2009 https://doi.org/10.1097/00005537-200301000-00032Citations: 44Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat Bibliography 1. Singer MI, Blom ED. An endoscopic technique for restoration of voice after laryngectomy. Ann Otol Rhinol Laryngol 1980; 89: 529–533. 2. Maniglia AJ, Lundy DS, Casiano RC, Swim SC. Speech restoration and complications of primary versus secondary tracheoesophageal puncture following total laryngectomy. Laryngoscope 1989; 99: 489–491. 3. Andrews JC, Mickel RA, Hanson DG, Monahan GP, Ward PH. Major complications following tracheoesophageal puncture for voice rehabilitation. Laryngoscope 1987; 97: 562–567. 4. Singer MI, Blom ED, Hamaker RC. Voice rehabilitation after total laryngectomy. J Otolaryngol 1983; 12: 329–334. 5. Parker GA. Simplified tracheoesophageal puncture for insertion of voice prosthesis. Laryngoscope 1985; 95: 608. 6. Le T, Wilson JS. A tracheo-esophageal puncture technique for voice restoration after laryngectomy. Gastrointest Endosc 1992; 38: 700–702. 7. Eliachar I, Wood BG, Lavertu P, Tucker HM. Improved endoscopic technique for establishment of tracheo-esophageal puncture. Otolaryngol Head Neck Surg 1994; 110: 242–246. 8. Rhys Evans PH. Tracheo-oesophageal puncture without tears: the forceps technique. J Laryngol Otol 1991; 105: 748–749. 9. Barkin JS, Hartford JD, Mikalov A, Flescher LM. Creation of tracheo-esophageal fistula for voice restoration using the flexible fiberoptic endoscope. Gastrointest Endosc 1991; 37: 469–470. 10. Hong GS, John AB, Theobald D, Soo KC. Flexible endoscopic tracheo-oesophageal puncture under local anaesthetic. J Laryngol Otol 1995; 109: 1077–1079. 11. Singh V, Brockbank MJ, Flower N, Frost RA. Tracheoesophageal puncture using a flexible gastroscope and a percutaneous endoscopic gastrostomy set. J Laryngol Otol 1997; 111: 447–448. 12. Chan H, Mesko T, Fields K, Barkin J. An improved method of flexible endoscopic creation of tracheoesophageal fistula for voice restoration. Surg Endosc 1997; 11: 1034–1035. 13. Koch WM. A fail-safe technique for endoscopic tracheoesophageal puncture. Laryngoscope 2001; 111: 1663–1665. 14. Maniglia AJ. Newer technique of tracheoesophageal fistula for vocal rehabilitation after total laryngectomy. Laryngoscope 1985; 95: 1064–1066. 15. Eerenstein SE, Schouwenburg PF. Secondary tracheoesophageal puncture with local anesthesia. Laryngoscope 2002; 112: 634–637. 16. Desyatnikova S, Caro JJ, Andersen PE, Cohen JI, Wax MK. Tracheoesophageal puncture in the office setting with local anesthesia. Ann Otol Rhinol Laryngol 2001; 110: 613–616. 17. Belafsky PC, Postma GN, Daniel E, Koufman JA. Transnasal esophagoscopy. Otolaryngol Head Neck Surg 2001; 125: 588–589. 18. Aviv JE, Takoudes TG, Ma G, Close LG. Office-based esophagoscopy: a preliminary report. Otolaryngol Head Neck Surg 2001; 125: 170–175. 19. Postma GN, Belafsky PC, Koufman JA. Distal esophageal diverticulum secondary to a reflux-induced stricture. Ear Nose Throat J 2001; 80: 500. Citing Literature Volume113, Issue1January 2003Pages 173-176 ReferencesRelatedInformation

OBJECTIVES/HYPOTHESIS:To review the current role of transnasal esophagoscopy (TNE) in all aspects of head and neck cancer patient treatment.STUDY DESIGN:A retrospective database and chart review.METHODS:A retrospective review of head and neck cancer patients undergoing TNE for a variety of diagnostic and therapeutic indications.RESULTS:In a series of 17 patients with presumed head and neck malignancies, TNE provided 100% accuracy in biopsy results and staging of the tumor when compared with standard panendoscopy. The utility of TNE in other areas of head and neck cancer management, such as stricture dilation and secondary tracheoesophageal puncture, is demonstrated. This preliminary report strongly suggests that TNE may play a vital role in the management of head and neck oncology patients.CONCLUSIONS:Transnasal esophagoscopy gives the surgeon the ability to perform a remarkable variety of procedures in the outpatient setting without sedation. It may obviate the need for routine panendoscopy in head and neck cancer patients.

Objective: To report the prevalence of esophagitis in patients with pH-documented laryngopharyngeal reflux. Study Design: Prospective study of 58 consecutive patients with documented laryngopharyngeal reflux, all of whom underwent transnasal esophagoscopy as part of their reflux evaluations. Methods: All patients with a diagnosis of laryngopharyngeal reflux confirmed by abnormal pharyngeal pH monitoring over a 5-month period were included, and all subjects completed a self-administered reflux symptom index and underwent transnasal esophagoscopy with directed biopsy. Results: Of the 58 study patients with pH-documented laryngopharyngeal reflux, the mean age was 49 years (+/- 13 y), and 53% (31 of 58) were women. Of the study group, 40% (23 of 58) had heartburn and 48% (28 of 58) had abnormal esophageal reflux (by pH monitoring criteria); by transnasal esophagoscopy with biopsy, 12% (7 of 58) had esophagitis and another 7% (4 of 58) had Barrett's metaplasia. Thus, 60% of the study cohort had no heartburn, and 81% (47 of 58) had normal esophageal epithelium (i.e., no esophagitis or Barrett's metaplasia). Conclusions: In the present series of patients with documented laryngopharyngeal reflux the prevalence of esophagitis and Barrett's metaplasia was only 19%. These data confirm the clinical impression that the patterns, mechanisms, and manifestations of laryngopharyngeal reflux differ from those of classic gastroesophageal reflux disease. Unlike gastroesophageal reflux disease, patients with laryngopharyngeal reflux uncommonly have esophagitis. Thus, although esophagoscopy may be an excellent method for screening the esophagus, it is not the method of choice for diagnosing laryngopharyngeal reflux.

BACKGROUND: Hyperkinetic vocal function (muscle tension dysphonia) may be an indication of underlying glottal insufficiency. In the face of an organic voice disorder such as presbylaryngis or vocal fold paresis. Hyperkinetic laryngeal behaviors may be used to achieve glottal closure. Such compensatory laryngeal behaviors may mask the correct underlying diagnosis. OBJECTIVE We sought to evaluate the association between vocal fold bowing due to presbylaryngis and abnormal muscle tension patterns (MTPs). METHODS: One hundred consecutive volunteers >40 years old were prospectively evaluated. All underwent a comprehensive head and neck examination that included transnasal fiberoptic laryngoscopy with videostroboscopy. Abnormal MTPs were compared in subjects with and without vocal fold bowing. RESULTS: The mean age of the cohort was 61 years. Eighty-four percent (42 of 50) of the male subjects and 60% (30 of 50) of female subjects had evidence of vocal fold bowing. Of the 72 patients with bowing, 94% (68 of 72) had abnormal MTPs. Compared with subjects without vocal fold bowing, persons with bowing were 17 times more likely to exhibit abnormal MTPs (P < 0.001). CONCLUSIONS: Abnormal MTPs are common in persons with underlying glottal insufficiency. Patients with vocal fold bowing are 17 times more likely to exhibit abnormal MTPs (95% confidence interval, 4.9 to 59.4). Clinicians should be aware that compensatory hyperkinetic laryngeal behaviors may mask an underlying organic condition.

The termreflux (derived from the Latin wordsre [“back”] andfluere [“to flow”]) literally meansbackflow. The termgastroesophageal reflux (GER) refers to the backflow of stomach contents into the esophagus. GER may be physiologic, and indeed up to 50 GER episodes a day, occurring mostly after meals, is accepted as being within the normal range. 1-3 Gastroesophageal reflux disease (GERD) is a clinical term that refers to GER that is excessive and that causes tissue damage (eg, esophagitis) and/or clinical symptoms (eg, heartburn). 1

OBJECTIVE:To determine whether treatment of laryngopharyngeal reflux reduces the laryngeal soft tissue complications encountered in surgery for recurrent respiratory papillomas.STUDY DESIGN:Retrospective chart review.METHODS:Retrospective chart review of all pediatric patients treated for laryngeal recurrent respiratory papillomas between 1984 and 1999 was performed. Thirty-one such patients were identified. Twenty-four were at "high risk" for developing complications based on the number of operating suite visits and the presence of disease at the anterior commissure. Twelve patients underwent 24-hour double pH probe testing.RESULTS:Overall, 13 of 31 patients (42%) developed laryngeal webs. No other soft tissue complications were encountered. Of the patients who had pH probe testing, 12 of 12 (100%) had at least one pharyngeal episode of acid exposure. Of the "high-risk" patients, 10 were treated for reflux and only 2 of 10 (20%) developed webs. Eleven of 14 (79%) of the "high-risk" patients who were not treated for reflux developed webs. The difference in rate of web formation between patients treated for reflux and those not treated for reflux was statistically significant (P =.011).CONCLUSIONS:Antireflux treatments for patients undergoing surgery for laryngeal recurrent respiratory papillomas may reduce the soft tissue complications, especially scarring and web formation. Prophylactic antireflux therapy may be warranted in any patient undergoing surgery during which laryngeal mucosal disruption is anticipated.

BACKGROUND: A pattern of edema on the ventral surface of the vocal fold, called pseudosulcus vocalis, was described in 1995. It refers to infraglottic edema extending from the anterior commissure to the posterior larynx. It can be differentiated from sulcus vergeture, which is caused by adhesion of the vocal fold epithelium to the vocal ligament. Although it has been related to laryngopharyngeal reflux (LPR), this has not been thoroughly investigated.PURPOSE: Our goal was to evaluate the association between pseudosulcus and LPR. METHODS: Thirty patients with a clinical diagnosis of LPR confirmed by double-probe pH monitoring and 30 controls without LPR were enrolled. The prevalence of pseudosulcus was determined with fiberoptic laryngoscopy.RESULTS: Seventy percent (21 of 30) of patients with LPR and 30% (9 of 30) of controls had pseudosulcus. Patients with pseudosulcus were 2.3 times more likely to have pH-documented LPR (95% confidence interval 1.3-4.2). The sensitivity and specificity of pseudosulcus in the diagnosis of LPR are 70% and 77%, respectively.CONCLUSIONS: Pseudosulcus is highly correlated with pH-documented LPR (P < 0.001). The presence of pseudosulcus is suggestive of LPR.

The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent. This technique may be used at the time of the primary cancer extirpation or as a secondary rehabilitative procedure. Generally, patients who have undergone this procedure have had minimal postoperative breathiness with good phonatory and airway function. We recommend this reconstructive technique for patients with large posterior defects following hemilaryngectomy.

Background: The evaluation of medical and surgical outcomes relies on methods of accurately quantifying treatment results. Currently, there is no validated instrument whose purpose is to document the physical findings and severity of laryngopharyngeal reflux (LPR). Objective. To evaluate the validity and reliability of the reflux finding score (RFS). Methods: Forty patients with LPR confirmed by double-probe pH monitoring were evaluated pretreatment and 2,4, and 6 months after treatment. The RFS was documented for each patient at each visit. For test-retest intraobserver reliability assessment, a blinded laryngologist determined the RFS on two separate occasions. To evaluate interobserver reliability, the RIPS was determined by two different blinded laryngologists. Results. The mean age of the cohort was 50 years (+/- 12 standard deviation [SDI). Seventy-three percent were women. The RFS at entry was 11.5 (+/- 5.2 SD). This score improved to 9.3 (+/- 4.7 SD) at 2 months, 7.3 (+/- 5.5 SD) at 4 months, and 6.1 (+/- 5.2 SD) at 6 months of treatment (P < .001 with trend). The mean RFS for laryngologist no. 1 was 10.8 (+/- 4.1 SD) at the initial screening and 10.8 (+/- 4.0 SD) at the repeat evaluation (r = 0.95, P < .001). The mean RFS for laryngologist no. 2 was 11.1 (+/- 3.8 SD) at the initial screening and 10.9 (+/- 3.7 SD) at the repeat evaluation (r = 0.95, P < .001). The correlation coefficient for interobserver variability was 0.90 (P < .001). Conclusions. The RIPS accurately documents treatment efficacy in patients with LPR It demonstrates excellent inter- and intraobserver reproducibility.

OBJECTIVES:To describe a new endoscopic technique for medialization of the laterally fixed arytenoid. The surgical technique, endoscopic arytenoid repositioning, is described, and the results of a series of cases are discussed.STUDY DESIGN:Retrospective chart review.METHODS:Eight patients underwent the procedure. Six patients were available for long-term follow-up. Preoperative and postoperative voice ratings were compared to evaluate the success of the procedure. Follow-up ranged from 3 to 64 months (mean follow-up, 31.5 mo).RESULTS:Long-term follow-up in six cases revealed that 67% (4 of 6) patients had normal or near-normal postoperative voices and one patient experienced moderate improvement. The mean preoperative voice score was 4.24, and the mean postoperative voice score was 1.83 (range, 1-5). The difference was statistically significant (P < 0.001).CONCLUSIONS:Endoscopic arytenoid repositioning is a newly described procedure with a very specific indication: a unilateral, laterally fixed arytenoid complex resulting in a severely dysphonic voice. Though technically demanding, this procedure provides a promising option for medialization of the posterior glottis in a scarred larynx.

INTRODUCTION:Glottal insufficiency resulting from vocal fold bowing, hypomobility, or scar is frequently treated by injection augmentation. Injection augmentation with fat, collagen, gel foam, polytef, and recently, fascia lata has been previously reported. Variable graft yield and poor host-tissue tolerance have motivated the continued search for an ideal graft substance. STUDY DESIGN:A prospective trial of autologous fascia augmentation of the vocal cord in the human and in an animal model. METHODS:Autologous fascia injection augmentation (AFIA) was evaluated in 8 canines and 40 patients at our institution between 1998 and 2000. The animal study compared graft yield from AFIA with autologous fat yield. The outcome measure was graft yield calculated from histological examination of larynges 12 weeks after injection augmentation. Clinical trial outcome measures included symptom surveys, acoustical voice analyses, and subjective voice assessments. Mean follow-up was 9 months. RESULTS:In the canine larynx, the mean graft yield for AFIA was 33% (range, 5%-84%) compared with autologous lipoinjection (47%; range, 7%-96%; P =.57). Subjective improvement in vocal quality was reported by 95% of patients (38 of 40) after AFIA. Preoperative and postoperative voice analysis data were obtained from 26 patients. Subjective voice rating demonstrated a significant improvement after AFIA (P <.0001). Acoustical parameters of jitter, shimmer, noise-to-harmonic ratio, phonatory range, and degree unvoiced improved significantly (P <.05) in all patients after fascia augmentation. CONCLUSIONS:Based on the animal study, we concluded that graft yields are excellent but variable for AFIA. The result is similar in variability and overall yield to autologous lipoinjection. Subjective and objective analyses of voice outcomes after AFIA are universally improved. Fascia appears to be an excellent alternative to lipoinjection in properly selected cases of glottic insufficiency.

Laryngopharyngeal reflux (LPR) in otolaryngology patients appears to be different from classic gastroesophageal reflux disease (GERD). In particular, esophagitis and its principal symptom, heartburn, considered the diagnostic sine qua non of GERD, are often absent in LPR. It has therefore been postulated that LPR patients have superior esophageal function. Esophageal acid clearance (EAC) is a measure of the ability of the esophagus to restore neutral pH after reflux events have occurred. It is considered an excellent overall measure of esophageal function. The mean EAC can be calculated from 24-hour pH monitoring data. A comparison of EAC in patients with GERD and LPR has not been previously reported. To compare the EAC of 1) patients with LPR alone, 2) patients with GERD alone, 3) patients with both LPR and GERD, and 4) patients without either LPR or GERD, we studied 200 otolaryngological patients who had undergone 24-hour double-probe (simultaneous pharyngeal and distal esophageal) pH monitoring, 50 in each group. The subgrouping of each patient was determined by previously established pH monitoring criteria. We defined GERD as abnormal esophageal reflux and LPR as abnormal pharyngeal reflux. The patients with GERD had a mean (±SD) EAC of 1.44 ± 1.2 minutes, and those with LPR had a mean EAC of 1.00 ± 1.00 minutes (p <.05). The patients with both GERD and LPR had a mean EAC of 1.53 ± 1.01 minutes. The patients without reflux had a mean EAC of 0.53 ± 0.38 minutes. We conclude that patients with LPR have significantly better EAC than those with GERD. These data suggest that patients with LPR have superior esophageal function. This finding may clarify our understanding of the differences in mechanisms, symptoms, and incidence of esophagitis in patients with LPR and GERD.

BACKGROUND: Laryngeal electromyography (LEMG) is a valuable diagnostic/prognostic test for patients with suspected laryngeal neuromuscular disorders.OBJECTIVE: To report our experience with diagnostic LEMG at the Center for Voice Disorders of Wake Forest University and to evaluate the impact of LEMG on clinical management.METHODS: Retrospective chart review of 415 patients who underwent diagnostic LEMG over a 5-year period (1995-1999).RESULTS: Of 415 studies, 83% (346 of 415) were abnormal, indicating a neuropathic process, LEMG results altered the diagnostic evaluation (eg, the type of radiographic imaging) in 11% (46 of 415) of the patients. Unexpected LEMG findings (eg, contralateral neuropathy) were found in 26% (107 of 415) of the patients, and LEMG results differentiated vocal fold paralysis from fixation in 12% (49 of 415). Finally, LEMG results altered the clinical management (eg, changed the timing and/or type of surgical procedure) in 40% (166 of 415) of the patients.CONCLUSIONS: LEMG is a valuable diagnostic test that aids the clinician in the diagnosis and management of laryngeal neuromuscular disorders.