Laryngeal adductor reflex hyperexcitability may predict permanent vocal fold paralysis

Catherine F. Sinclair, Maria J. Téllez, M. Angeles Sánchez Roldán, Sedat Ulkatan

Research output: Contribution to journalArticlepeer-review


Laryngeal adductor reflex–continuous intraoperative neuromonitoring (LAR-CIONM) is a novel method of continuous intraoperative neuromonitoring. In contrast to other vagal nerve monitoring techniques, which elicit a laryngeal compound muscle action potential, LAR-CIONM elicits a laryngeal reflex response (LAR). In 300 nerves at risk monitored with LAR-CIONM, two patients have had postoperative permanent vocal fold immobility (VFI). Both patients exhibited a significant LAR amplitude increase prior to complete loss of signal. No other patients have exhibited LAR hyperexcitability. If confirmed in a larger sample, this represents the first time that a vagal intraoperative neuromonitoring technique can distinguish transient from permanent VFI, which could improve patient outcomes. Laryngoscope, 2019 Laryngoscope, 130:E625–E627, 2020.

Original languageEnglish
Pages (from-to)E625-E627
Issue number11
StatePublished - 1 Nov 2020
Externally publishedYes


  • Neuromonitoring
  • larynx
  • neurolaryngology
  • reflex
  • thyroid
  • vocal fold paralysis


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