FRCS (ORL-HNS) · SECTION 1 SBA

Laryngeal electromyography in vocal-fold paralysis

Three months after thyroid surgery, a patient has unilateral vocal-fold immobility and aspiration. Laryngeal EMG shows no voluntary motor-unit recruitment in the thyroarytenoid muscle. How should this finding be used?

CHOOSE ONE ANSWER

Best of five

  1. A. As proof that permanent thyroplasty must occur immediately
  2. B. As evidence that the opposite vocal fold is paralysed
  3. C. As a substitute for swallowing assessment
  4. D. As a reason to avoid any intervention
  5. E. As one prognostic input when discussing recovery and timing of durable medialisation
ANSWER AND REASONING

E. As one prognostic input when discussing recovery and timing of durable medialisation

EMG can inform prognosis but must be interpreted with clinical course, endoscopic findings and swallowing impact; it does not make management automatic.

Why every option is right or wrong

A. As proof that permanent thyroplasty must occur immediately: Timing depends on aspiration, voice, recovery potential and patient priorities.

B. As evidence that the opposite vocal fold is paralysed: The test concerns the sampled muscle and nerve supply.

C. As a substitute for swallowing assessment: Aspiration management requires functional assessment.

D. As a reason to avoid any intervention: Poor recruitment may support earlier counselling about durable solutions.

E. As one prognostic input when discussing recovery and timing of durable medialisation: EMG can inform prognosis but must be interpreted with clinical course, endoscopic findings and swallowing impact; it does not make management automatic.

What if the scenario changed?

If serial examination showed clear recovering movement, temporary rather than permanent medialisation might be favoured.