근긴장성 발성장애 환자의 후두마사지 효과: 표면근전도 활동 변화

김보겸,최성희,이경재,최철희 한국언어청각임상학회 2023 Communication Sciences and Disorders Vol.28 No.3

Objectives: Laryngeal massage has been used as a major voice therapy technique in patients with muscle tension dysphonia, which results in voice changes due to excessive tension in the intrinsic or extrinsic laryngeal muscles. This study aims to explore the effect of laryngeal massage by changing the activity potentials of paralaryngeal muscles through laryngeal massage. Methods: A total of 15 adults diagnosed with muscle tension dysphonia participated in this study. Laryngeal massage was performed for 15-20 minutes. To measure surface electromyography (sEMG), the surface electrodes were attached to the suprahyoid muscle and sternocleidomastoid (SCM) muscles of each patient and the sEMG activity of the paralaryngeal muscles was measured before and after laryngeal massage. In addition, a patient-based pain scale was also completed by laryngeal palpation before and after laryngeal massage. Results: Significantly lower sEMG amplitudes yielded in the suprahyoid muscle and SCM muscles during sustained /a/ vowel phonation and connected speech following laryngeal massage. Moreover, pain scores also reduced after laryngeal massage in both the suprahyoid and sternocleidomastoid muscles. Conclusion: Laryngeal massage was immediately beneficial in reducing tension and pain in the paralaryngeal muscles for muscle tension dysphonia. In addition, sEMG proved the effect of laryngeal massage alone without other interventions as an objective indicator. Hence, it can be useful to measure the therapeutic effect of laryngeal massage for muscle tension dysphonia with laryngeal palpation in the clinical field.

비침습적 방법에 의한 후두유발근전도 검사

정성민,조선희,박기덕 대한후두음성언어의학회 1999 대한후두음성언어의학회지 Vol.10 No.1

Background and Objectives : Laryngeal Evoked Electromyography(EEMG) is a objective, quantitative technique to determine innervation status of larynx. The possible applications of this technique are to confirm the etiology of impaired vocal fold motion and monitor perioperative vagus nerve trauma. The purpose of this study is to develop a novel method for determining the amount of reinnervation of recurrent laryngeal nerve with accurate, inexpensive, and minimally invasive technique in human. Materials and Methods : Laryngeal EEMG was performed for 16 adults with intact vocal folds motion and 2 patients diagnosed as unilateral vocal fold paralysis. for the purpose of searching what is the optimal and noninvasive technique for laryngeal EEMG, we used 2 types of stimulation configurations(transcutaneous vs percutaneous) and 2 types of recording configurations(intramuscular vs. surface). Results and Conclusions : Percutaneous needle stimulation and surface recording of laryngeal EEMG was reliable and comparable to standard needle stimulation and invasive intramuscular needle recording. But the laryngeal EEMG by the surface recording and transcutaneous surface stimulation was not reliable and repeatable. Therefore we recommended that laryngeal EEMG by surface recording and percutaneous needle stimulation would be minimally invasive, reliable technique to know the status of reinnervation in e patients with vocal fold paralysis.

성대마비환자를 대상으로 시행한 후두근전도검사의 임상적 유용성

최홍식,최영준,문상우,김태만,최홍식,최영준,문상우,김태만 대한이비인후과학회 1999 대한이비인후과학회지 두경부외과학 Vol.42 No.2

Comparison of Clinical Characteristics Between Patients With Different Causes of Vocal Cord Immobility

Kim, Min-Hyun,Noh, Junsoo,Pyun, Sung-Bom Korean Academy of Rehabilitation Medicine 2017 Annals of Rehabilitation Medicine Vol.41 No.6

<P><B>Objective</B></P><P>To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI).</P><P><B>Methods</B></P><P>The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group.</P><P><B>Results</B></P><P>Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched ‘e’ sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched ‘e’ sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018).</P><P><B>Conclusion</B></P><P>In patients with suspected vocal cord palsy, impaired high pitched ‘e’ sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.</P>

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

성의숙,이진춘,신성찬,권현근,나한슬,박다희,최성욱,노정훈,이병주 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.4

Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods. We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle. Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion. Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor During Thyroid Surgery: A Porcine Model Study

성의숙,신성찬,권현근,김지아,박다희,최성욱,김상훈,이진춘,노정훈,이병주 대한이비인후과학회 2020 Clinical and Experimental Otorhinolaryngology Vol.13 No.3

Objectives. The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model. Methods. We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared. Results. No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery. Conclusion. The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.

Pathophysiological Mechanisms Underlying Unilateral Vocal Fold Paralysis in Female Patients: An Ultrasonographic Study

Yi-An Lu,Tuan-Jen Fang,Yu-Cheng Pei,Yun-Chen Tsai,Wan-Ni Lin 대한이비인후과학회 2023 Clinical and Experimental Otorhinolaryngology Vol.16 No.4

Objectives. Laryngeal ultrasonography (LUS) has been suggested as an alternative diagnostic tool for unilateral vocal foldparalysis (UVFP). The present study applied LUS and quantitative laryngeal electromyography (LEMG) in female UVFPpatients to investigate the pathophysiologic mechanisms of UVFP. Methods. In this cross-sectional study, vocal fold (VF) length parameters included resting and phonating VF length measuredusing B-mode LUS, and color Doppler vibrating length (CDVL) measured using the color Doppler mode. Results. Forty female patients with UVFP were enrolled, among whom 11 and 29 were assigned to the thyroarytenoid (TA)muscle+cricothyroid (CT) muscle group (with CT involvement) and the TA (without CT involvement) group, respec-tively. In the TA group, the turn frequency in thyroarytenoid-lateral cricoarytenoid (TA-LCA) on the paralyzed side,as observed through LEMG, correlated with the VF length during the resting phase (R =0.368, P =0.050) and CDVLvalues (R =0.627, P =0.000) on the paralyzed side. In the TA+CT group, the turn ratio in the CT muscle correlatedwith the normalized phonatory vocal length change (nPLC; R =0.621, P =0.041) on the paralyzed side. Conclusion. CDVL and nPLC are two parameters that can be utilized to predict the turn frequencies of TA-LCA in UVFPcases without CT involvement, and the turn ratio of CT in cases of UVFP with CT involvement, respectively. The find-ings suggest that LUS, as a noninvasive tool, can serve as an alternative method for assessing the severity of laryngealnerve injury and offer valuable insights into the pathophysiology of UVFP.

흉부 외상 후 발생한 미주신경 손상에 의한 속발성 식도 이완불능증 −증례 보고−

박기철,김민영,강진영,이학일,류주석 대한재활의학회 2010 Annals of Rehabilitation Medicine Vol.34 No.5

Achalasia is rare disorder with an estimated prevalence of 0.5∼1 per 100,000 per year and secondary achalasia due to trauma is rarer. The following case report describes a patient who developed achalasia after chest trauma. This report presents a 22 year-old male with chest trauma who had hoarseness and postprandial reflux. We suggested the achalasia through video-fluoroscopic swallowing study (VFSS), and confirmed superior and recurrent laryngeal neuropathies through laryngeal electromyography (EMG). VFSS and laryngeal EMG are helpful to diagnose the achalasia due to vagus nerve injury after chest trauma. (J Korean Acad Rehab Med 2010; 34: 603-606)

갑상선 수술 중 신경 손상을 피하기 위한 수술 중 신경 모니터링의 활용

지용배(Yong Bae Ji) 대한신경모니터링학회 2021 Journal of Neuromonitoring & Neurophysiology Vol.1 No.1

Traditionally, visual identification of the nerve is the gold standard to avoid injury. Intraoperative neural monitoring (IONM) has been world-widely popularized in thyroid and parathyroid surgery because it helps identify the nerve. Despite the increasing use of IONM, there is a controversy that IONM can reduce recurrent laryngeal nerve (RLN) injury. It may be derived from the lack of uniformity in the application of and results from nerve monitoring between surgeons. IONM can not only be used to check the nerves, but it can also provide a lot of information to the surgeon. By using this information properly, the function of nerves can be monitored sensitively during surgery, and through this, a surgeon can be relatively freed from nerve damage. Proper use of IONM can improve the quality of neural monitoring and drive surgeons to best practices. In this paper, consistent and useful use of IONM has been described.

Development of a Novel Intraoperative Neuromonitoring System Using a Surface Pressure Sensor to Detect Muscle Movement: A Rabbit Model Study

성의숙,이진춘,신성찬,권현근,김민식,김동주,노정훈,이병주 대한이비인후과학회 2019 Clinical and Experimental Otorhinolaryngology Vol.12 No.2

Objectives. False-negative or false-positive responses in intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroid surgery pose a challenge. Therefore, we developed a novel IONM system that uses a surface pressure sensor instead of EMG to detect muscle twitching. This study aimed to investigate the feasibility and safety of a new IONM system using a piezo-electric surface pressure sensor in an experimental animal model. Methods. We developed the surface pressure sensor by modifying a commercial piezo-electric sensor. We evaluated the stimulus thresholds to detect muscle movement, as well as the amplitude and latency of the EMG and surface pressure sensor in six sciatic nerves of three rabbits, according to the stimulus intensity. Results. The surface pressure sensor detected the muscle movements in response to a 0.1 mA stimulation of all six sciatic nerves. There were no differences in the thresholds of stimulus intensity between the surface pressure sensor and EMG recordings to detect muscle movements. Conclusion. It is possible to measure the change in surface pressure by using a piezo-electric surface pressure sensor instead of EMG to detect muscle movement induced by nerve stimulation. The application of IONM using a piezo-electric surface pressure sensor during surgery is noninvasive, safe, and feasible. Measuring muscle twitching to identify the state of the nerves using the novel IONM system can be an alternative to recording of EMG responses.