Laryngeal electromyography (LEMG) predicts a poor vocal fold recovery with a positive predictive value of 90.9%, yet when it signals recovery it is right only 55.6% of the time (The Laryngoscope, Rickert et al. meta-analysis 2012). That asymmetry runs through 25 years of studies: a 2015 prospective cohort measured 91.7% sensitivity but just 44.4% specificity (The Laryngoscope, Wang et al. 2015), and a prospective series of 50 patients found that LEMG altered the treatment plan in 36% of them (The Laryngoscope, Ingle et al. 2014). Adoption lags the evidence, with only 28% of respondents to a German and European neurolaryngology specialist survey using LEMG regularly (European Archives of Oto-Rhino-Laryngology, Volk et al. 2018). This roundup takes the diagnostic angle, while our companion piece on vocal fold paralysis and injection medialization statistics covers treatment. We aggregated data from the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM), the Neurolaryngology Study Group, the European Laryngological Society, the Korean Society of Laryngology, Phoniatrics and Logopedics, and more than 20 peer-reviewed studies in The Laryngoscope, Journal of Voice, Otolaryngology-Head and Neck Surgery and Muscle and Nerve.
TL;DR
- LEMG has a pooled PPV of 90.9% for poor recovery and an NPV of 55.6% for return of motion across 503 patients (Laryngoscope, Rickert et al. 2012).
- A prospective cohort of 84 patients measured 86.4% accuracy, 91.7% sensitivity and 44.4% specificity (Laryngoscope, Wang et al. 2015).
- Done more than 2 months after symptom onset, LEMG reached a PPV of 97.9% (Laryngoscope, Wang et al. 2015).
- Motor unit potentials raise the likelihood of recovery by 52.6%, while fibrillations do not predict outcome (AANEM Consensus Statement 2016).
- 89% of chronically paralyzed vocal folds (24 of 27) still showed motor unit potentials a median 8.5 months after injury (Laryngoscope, Lin et al. 2018).
- Adding synkinesis analysis lifted NPV from 53% to 100% and sensitivity from 56% to 100% (Laryngoscope, Statham et al. 2010).
- Seven experienced neurolaryngologists agreed on LEMG readings with a Fleiss’ kappa of 0.61 (European Archives of Oto-Rhino-Laryngology, Ho et al. 2019).
- 16% of healthy adults with normal voices showed at least one abnormal synkinesis finding (Laryngoscope, Leclerc et al. 2021).
- 3.6% of 500 patients had a complication after LEMG, half of them pain (Journal of Voice, Quindlen et al. 2025).
- Only 21% of surveyed laryngologists performed LEMG in more than half of suspected paresis cases (Laryngoscope, Wu and Sulica 2015).
- The Korean society guideline on unilateral vocal fold paralysis gives LEMG a strong recommendation based on high-quality evidence (Korean Society of Laryngology, Phoniatrics and Logopedics Guideline 2020).
1. Prognostic Accuracy: How Well LEMG Predicts Recovery
The headline finding is that LEMG is a rule-in test for permanent paralysis, not a rule-out test. In the meta-analysis that the Korean guideline relies on, 296 of 503 patients (58.8%) had findings predicting a poor prognosis, and 269 of them did recover poorly. Among the 207 patients whose tracings looked favorable, 88 (44.4%) still never regained motion (Rickert et al., The Laryngoscope 2012).
The same pattern repeats across independent cohorts, with PPVs in the 90s and NPVs between 40% and 60%. The one outlier is quantitative LEMG, where measured rather than eyeballed signal analysis pushed NPV to 89.5% in a 23-patient series. For clinicians this means a poor tracing justifies moving early to durable treatment, while a good tracing justifies only watchful waiting with a plan B. Most recent available data for the pooled estimate: Rickert et al., The Laryngoscope 2012.
| Metric | Value | Source |
|---|---|---|
| Pooled PPV for poor recovery (503 patients) | 90.9% (269/296) | The Laryngoscope, Rickert et al. meta-analysis 2012 |
| Pooled NPV for return of motion | 55.6% (115/207) | The Laryngoscope, Rickert et al. meta-analysis 2012 |
| Pooled odds ratio, LEMG prognosis vs outcome | 11.56 (95% CI 7.10-18.81) | The Laryngoscope, Rickert et al. meta-analysis 2012 |
| Accuracy / sensitivity / specificity (84-patient prospective cohort) | 86.4% / 91.7% / 44.4% | The Laryngoscope, Wang et al. 2015 |
| PPV / NPV in the same cohort | 93.0% / 40.0% | The Laryngoscope, Wang et al. 2015 |
| PPV for defective healing / NPV for recovery (448 patients) | 97% / 60% | The Laryngoscope, Grosheva et al. 2008 |
| Defective recovery predicted correctly vs complete recovery predicted correctly (98 patients) | 94.4% (68/72) vs 12.8% (5/39) | Archives of Otolaryngology-Head and Neck Surgery, Sittel et al. 2001 |
| Quantitative LEMG PPV / NPV (23 patients) | 100% / 89.5% | The Laryngoscope, Smith et al. 2012 |
Context note: children are a separate evidence base. A 2026 systematic review of 33 pediatric studies pooled a sensitivity of 82% (95% CI: 51-96%) from three studies, and the width of that interval shows how thin the pediatric data still is (Gyawali et al., International Journal of Pediatric Otorhinolaryngology 2026).
2. Which Signals Matter: Recruitment, Polyphasic Potentials, Fibrillations and Synkinesis
Not every waveform carries prognostic weight. The AANEM’s systematic review, built on American Academy of Neurology criteria, found that the presence of motor unit potentials raised the likelihood of recovery by 52.6%, while positive sharp waves and fibrillation potentials, the classic markers of denervation, did not predict outcome at all (AANEM Consensus Statement, Muscle and Nerve 2016).
Synkinesis is one reason favorable-looking studies fail. When nerve fibers regrow into the wrong muscles, the needle records activity but the fold still does not move purposefully. In one 124-exam series, synkinesis was present in 9.7% of patients, yet adding it to the analysis transformed the test’s NPV (Statham et al., The Laryngoscope 2010). A 2025 prospective cohort adds nuance: spontaneous activity predicted decreased recruitment at long-term follow-up but not the quantitative peak turn frequency, so its authors argue it should be read alongside recruitment (Tseng et al., Otolaryngology-Head and Neck Surgery 2025).
| Metric | Value | Source |
|---|---|---|
| Motor unit potentials present: increase in likelihood of recovery | 52.6% (absolute risk difference 0.526, 95% CI 0.387-0.664) | AANEM Consensus Statement 2016 |
| Polyphasic MUPs within 6 months: increase in likelihood of recovery | 44.8% (0.448, 95% CI 0.217-0.681) | AANEM Consensus Statement 2016 |
| Electrical synkinesis: increase in likelihood of immobility (1 study) | 60.7% (95% CI 0.352-0.861) | AANEM Consensus Statement 2016 |
| Synkinesis-positive patients among consecutive exams | 9.7% (12/124) | The Laryngoscope, Statham et al. 2010 |
| NPV / sensitivity before and after adding synkinesis analysis | 53% to 100% / 56% to 100% | The Laryngoscope, Statham et al. 2010 |
| Spontaneous activity present at baseline (prospective cohort) | 87 of 124 patients | Otolaryngology-Head and Neck Surgery, Tseng et al. 2025 |
| Children with MUAPs present: hazard ratio for recovery | 5.56 (95% CI 1.65-18.71, p = 0.00558) | International Journal of Pediatric Otorhinolaryngology, Gyawali et al. 2026 |
| Fair-to-poor LEMG: sensitivity / specificity for persistent paralysis (31 cases) | 91% / 44% | Munin et al. 2003, as reviewed in the Neurolaryngology Study Group Recommendations 2009 |
Context note: the Korean UVFP guideline uses a practical threshold, treating motor unit recruitment below 80% of the normal side, or synkinesis, as a sign of poor prognosis.
3. Timing: When the Test Is Done Changes What It Can Say
LEMG is a moving picture captured as a still. Done too early, the denervation signs have not yet appeared. Done too late, recovery has either happened or stalled. The Korean guideline notes that pathologic spontaneous activity does not appear until 10-14 days after injury, that most authors suggest testing within 6 weeks, and that LEMG after 6 months is regarded as inaccurate (Korean Society of Laryngology, Phoniatrics and Logopedics UVFP Guideline 2020).
The data also explain why later tests look more accurate: by 2 months the nerve has largely shown its hand, so a poor tracing at that point is almost never wrong. The trade-off is lost time, since the natural recovery window is mostly over by 6 to 9 months. Even well past that window, a chronically paralyzed fold is rarely electrically silent, which matters for anyone considering reinnervation surgery (Lin et al., The Laryngoscope 2018).
| Metric | Value | Source |
|---|---|---|
| Recommended window for prognostic LEMG | More than 4 weeks and less than 6 months after onset | AANEM Consensus Statement 2016 |
| Earliest appearance of spontaneous activity after injury | 10-14 days | Korean UVFP Guideline 2020 |
| Mean time from onset to LEMG / mean follow-up (prospective cohort) | 3.7 months / 18.4 months | The Laryngoscope, Wang et al. 2015 |
| PPV when LEMG is done more than 2 months after onset | 97.9% | The Laryngoscope, Wang et al. 2015 |
| Mean regeneration time, neuropraxia vs axonotmesis/neurotmesis | 4.0 vs 5.6 months | The Laryngoscope, Grosheva et al. 2008 |
| Recoverable UVFP that recovered within 6 months / within 9 months (727 cases) | 86% / 96% | Mau et al., as cited in the Korean UVFP Guideline 2020 |
| Chronic paralysis (median 8.5 months from injury): folds with motor unit potentials | 89% (24 of 27) | The Laryngoscope, Lin et al. 2018 |
Context note: the original Sittel series tested no earlier than 14 days after onset and judged outcome at 6 months, which is why many protocols still use a 2-week floor (Archives of Otolaryngology-Head and Neck Surgery, Sittel et al. 2001).
4. Diagnostic Yield: How Often LEMG Changes the Diagnosis or the Plan
Prognosis is only half of the test’s value. The other half is catching the patient whose fold is not paralyzed at all, such as a fixed cricoarytenoid joint, or whose weakness is a superior laryngeal nerve problem missed on endoscopy. Pooled across five studies, LEMG changed the diagnosis or management in 48% of cases (95% CI 30.1%-65.9%), with cricoarytenoid fixation and superior laryngeal neuropathy the most common alternative diagnoses (AANEM Consensus Statement 2016).
The prospective data are more modest than the retrospective series, which is the expected direction once selection bias is reduced. In 50 consecutive patients studied prospectively, LEMG changed the diagnosis in 10% but altered the treatment plan in 36%, mostly by moving patients toward permanent treatment (Ingle et al., The Laryngoscope 2014). LEMG sits beside imaging and acoustic voice analysis in dysphonia workups, and is one of the few tools that separates neural weakness from functional patterns such as muscle tension dysphonia.
| Metric | Value | Source |
|---|---|---|
| Diagnosis changed / treatment plan altered (50 prospective patients) | 10% (5/50) / 36% (18/50) | The Laryngoscope, Ingle et al. 2014 |
| Patients moved to permanent treatment after LEMG | 13 of 50 | The Laryngoscope, Ingle et al. 2014 |
| LEMG changed the medical plan / confirmed the course (37 patients) | 27.0% / 32.4% | Heman-Ackah and Barr, as cited in the Korean UVFP Guideline 2020 |
| Neurologic cause identified by LEMG (61 patients) | 85% | Focquet et al., as cited in the Korean UVFP Guideline 2020 |
| Management altered by LEMG (Wake Forest, 1995-1999) | 63% | Koufman et al. 2001, as reviewed in the Neurolaryngology Study Group Recommendations 2009 |
| Share of 337 unilateral immobility cases due to injury / idiopathic | 52.5% / 21.4% | Journal of Voice, Hu et al. 2023 |
| Neuropraxia vs axonotmesis/neurotmesis on EMG (448 patients) | 31.0% vs 40.8% (28.1% not classifiable) | The Laryngoscope, Grosheva et al. 2008 |
Context note: the Grosheva cohort was dominated by thyroid surgery (42.9%) and idiopathic paralysis (20.3%), so its accuracy figures may not transfer cleanly to cardiothoracic or skull-base cases.
5. Reliability and Technique: Agreement, False Positives and Needle Placement
LEMG remains largely a qualitative test, as the Neurolaryngology Study Group stated in 2009, and qualitative tests live or die on who reads them (Blitzer et al., Neurolaryngology Study Group Recommendations, Otolaryngology-Head and Neck Surgery 2009). When seven experienced neurolaryngologists rated 52 representative recordings, overall agreement reached a Fleiss’ kappa of 0.61, which leaves real room for two experts to read the same tracing differently (Ho et al., European Archives of Oto-Rhino-Laryngology 2019).
Normal variation is the second blind spot. In healthy adults with normal voices, abnormal findings were not rare, particularly for synkinesis (Leclerc et al., The Laryngoscope 2021). Technique matters too: in a 111-patient series, half of the necks had poorly palpable landmarks (Lin et al., The Laryngoscope 2024). Quantitative turns analysis is one answer; in a study of 44 adults with unilateral vocal fold immobility, turns per second correlated with qualitative ratings at r = 0.853 (Kneisz et al., European Archives of Oto-Rhino-Laryngology 2020).
| Metric | Value | Source |
|---|---|---|
| Inter-rater agreement, 7 neurolaryngologists (Fleiss’ kappa) | 0.61 | European Archives of Oto-Rhino-Laryngology, Ho et al. 2019 |
| Pairwise inter-rater agreement range (Cohen’s kappa) | 0.48-0.84 | European Archives of Oto-Rhino-Laryngology, Ho et al. 2019 |
| Healthy adults with at least one abnormal qualitative / synkinesis finding (46 participants) | 4% / 16% | The Laryngoscope, Leclerc et al. 2021 |
| Per-muscle likelihood of an abnormal finding: qualitative / synkinesis / turns/s | 2.2% / 9.3% / 5.4% | The Laryngoscope, Leclerc et al. 2021 |
| Exams rated extremely challenging (111 patients) | 12.8% | The Laryngoscope, Lin et al. 2024 |
| Exams with poorly palpable surface anatomy | 50.5% | The Laryngoscope, Lin et al. 2024 |
| Findings in which clinicians felt confident | 76.1% | The Laryngoscope, Lin et al. 2024 |
| Thyroarytenoid muscle identified by ultrasound guidance (20 patients) | 85% (17 of 20) | Journal of Voice, Park et al. 2016 |
Context note: the normal threshold used in quantitative LEMG is more than 400 turns per second (Smith and Munin, Muscle and Nerve 2025), and an early turns-and-amplitude study recorded 450 vs 290 turns per second (P = .002) when comparing its 21 controls with 16 patients with unilateral paralysis (Statham et al., turns and amplitude analysis, The Laryngoscope 2010).
6. Safety and Patient Tolerance
For a test that involves needles through the neck into the larynx, the complication data are reassuring. Only 18 of 500 patients (3.6%) had any complication in a seven-year safety review, and the reported events were pain, voice changes, procedural difficulty and a single case of excessive bleeding (Quindlen et al., Journal of Voice 2025).
Tolerance is the more relevant barrier. In a 2026 single-center study, roughly a third of patients rated the experience as excellent and another third as good, but about one in eight landed in the poor or very poor categories (Tarabichi et al., Journal of Medicine and Life 2026). In a separate 111-patient series, patient intolerance was named as a challenge in 15.6% of exams, and every restless minute reduces how much signal the clinician can collect.
| Metric | Value | Source |
|---|---|---|
| Patients with any complication (500 patients, 2015-2022) | 3.6% (18/500) | Journal of Voice, Quindlen et al. 2025 |
| Complication rate, males vs females | 2.1% vs 4.5% | Journal of Voice, Quindlen et al. 2025 |
| Share of complications that were pain / voice changes / excessive bleeding | 50% / 27.78% / 5.56% | Journal of Voice, Quindlen et al. 2025 |
| Patient tolerance rated excellent / good (97 patients) | 32.99% / 34.02% | Journal of Medicine and Life, Tarabichi et al. 2026 |
| Patient tolerance rated poor / very poor | 9.28% / 3.09% | Journal of Medicine and Life, Tarabichi et al. 2026 |
| Mean patient-reported pain on a visual analog scale | 35 ± 24 | The Laryngoscope, Lin et al. 2024 |
| Exams where patient intolerance was a technical challenge | 15.6% | The Laryngoscope, Lin et al. 2024 |
Context note: the “one in eight” figure combines the poor (9.28%) and very poor (3.09%) categories, which sum to 12.37%.
7. Adoption, Guidelines and Practice Patterns
Four guideline or consensus documents back LEMG (the Neurolaryngology Study Group in 2009, the European Laryngological Society in 2012, the AANEM in 2016 and Korea in 2020), yet routine use remains a minority practice. Korea’s 2020 guideline gives LEMG a strong recommendation on high-quality evidence for both differentiating paralysis from mechanical fixation and providing prognostic information, and the AANEM consensus statement was reaffirmed in October 2022 after its review panel judged that newer studies did not warrant revision. Only 28% of respondents to a specialist survey run by the German and European Laryngological Society neurolaryngology working groups regularly used LEMG (Volk et al., European Archives of Oto-Rhino-Laryngology 2018).
Among laryngology-focused physicians, LEMG is used more as a selective tool than as a first-line test: 72% of survey respondents relied principally on strobovideolaryngoscopy to diagnose paresis (Wu and Sulica, The Laryngoscope 2015). The specialists who do perform it are a small, concentrated group, and the same expertise is used in LEMG-guided botulinum toxin therapy for spasmodic dysphonia. Most recent available data for laryngologist practice patterns: Wu and Sulica, The Laryngoscope 2015.
| Metric | Value | Source |
|---|---|---|
| American Broncho-Esophagological Association respondents who rely on LEMG for adult unilateral vocal fold immobility | 75% (n = 57) | Annals of Otology, Rhinology and Laryngology, Halum et al. 2005 |
| Laryngologists performing LEMG in more than 50% of suspected paresis cases | 21% (12 of 58) | The Laryngoscope, Wu and Sulica 2015 |
| Laryngologists relying principally on LEMG to diagnose paresis | 1.7% (1 of 58) | The Laryngoscope, Wu and Sulica 2015 |
| German and ELS specialists regularly using LEMG / perceived predictive value of pathologic LEMG | 28% / 79 ± 23% | European Archives of Oto-Rhino-Laryngology, Volk et al. 2018 |
| International LEMG experts performing 10-40 exams per year (37 respondents, 2021) | 56.8% | Acta Otorrinolaringologica Espanola, Ramirez-Ruiz et al. 2024 |
| LEMG experts who are otolaryngologists / neurologists | 70.3% / 27% | Acta Otorrinolaringologica Espanola, Ramirez-Ruiz et al. 2024 |
| LEMG experts using bipolar / monopolar concentric needle electrodes | 45.9% / 40.5% | Acta Otorrinolaringologica Espanola, Ramirez-Ruiz et al. 2024 |
| European guideline panel: patients examined jointly to build consensus | More than 20 | European Archives of Oto-Rhino-Laryngology, Volk et al. ELS proposal 2012 |
Context note: the Halum figure comes from a 2005 survey with a 34% response rate and should not be read as current US practice (Halum et al., Annals of Otology, Rhinology and Laryngology 2005). The ELS guideline proposal is available from European Archives of Oto-Rhino-Laryngology.
Summary: Laryngeal Electromyography by the Numbers
| Metric | Value | Source |
|---|---|---|
| Pooled PPV for poor recovery | 90.9% | The Laryngoscope, Rickert et al. 2012 |
| Pooled NPV for return of motion | 55.6% | The Laryngoscope, Rickert et al. 2012 |
| Sensitivity / specificity (prospective cohort) | 91.7% / 44.4% | The Laryngoscope, Wang et al. 2015 |
| PPV when done more than 2 months after onset | 97.9% | The Laryngoscope, Wang et al. 2015 |
| PPV / NPV in 448 patients | 97% / 60% | The Laryngoscope, Grosheva et al. 2008 |
| Quantitative LEMG PPV / NPV | 100% / 89.5% | The Laryngoscope, Smith et al. 2012 |
| Motor unit potentials: increase in likelihood of recovery | 52.6% | AANEM Consensus Statement 2016 |
| Chronic paralysis: folds still showing motor unit potentials | 89% (24 of 27) | The Laryngoscope, Lin et al. 2018 |
| NPV after adding synkinesis analysis | 53% to 100% | The Laryngoscope, Statham et al. 2010 |
| Pediatric pooled sensitivity | 82% (95% CI: 51-96%) | International Journal of Pediatric Otorhinolaryngology, Gyawali et al. 2026 |
| Earliest spontaneous activity after injury | 10-14 days | Korean UVFP Guideline 2020 |
| Treatment plan altered (prospective) | 36% | The Laryngoscope, Ingle et al. 2014 |
| Inter-rater agreement (Fleiss’ kappa) | 0.61 | European Archives of Oto-Rhino-Laryngology, Ho et al. 2019 |
| Healthy adults with abnormal synkinesis finding | 16% | The Laryngoscope, Leclerc et al. 2021 |
| Complication rate (500 patients) | 3.6% | Journal of Voice, Quindlen et al. 2025 |
| Tolerance rated excellent or good | 32.99% / 34.02% | Journal of Medicine and Life, Tarabichi et al. 2026 |
| Exams rated extremely challenging | 12.8% | The Laryngoscope, Lin et al. 2024 |
| Specialists regularly using LEMG (Germany/ELS) | 28% | European Archives of Oto-Rhino-Laryngology, Volk et al. 2018 |
| Laryngologists using LEMG in more than half of suspected paresis | 21% | The Laryngoscope, Wu and Sulica 2015 |
Methodology and Sources
- AANEM, Consensus Statement: Using Laryngeal EMG for the Diagnosis and Treatment of Vocal Cord Paralysis (Munin et al., Muscle and Nerve 2016; reaffirmed October 2022): aanem.org
- Rickert SM et al., Laryngeal electromyography for prognosis of vocal fold palsy: a meta-analysis, The Laryngoscope 2012: doi.org/10.1002/lary.22354
- Blitzer A et al., Recommendations of the Neurolaryngology Study Group on laryngeal electromyography, Otolaryngology-Head and Neck Surgery 2009: PMC2758662
- Volk GF et al., Laryngeal electromyography: a proposal for guidelines of the European Laryngological Society, European Archives of Oto-Rhino-Laryngology 2012: doi.org/10.1007/s00405-012-2036-1
- Korean Society of Laryngology, Phoniatrics and Logopedics Guideline Task Force, Guidelines for the Management of Unilateral Vocal Fold Paralysis, Clinical and Experimental Otorhinolaryngology 2020: PMC7669319
- Wang CC et al., Laryngeal electromyography and prognosis of unilateral vocal fold paralysis: a long-term prospective study, The Laryngoscope 2015: doi.org/10.1002/lary.24980
- Grosheva M et al., Evaluation of peripheral vocal cord paralysis by electromyography, The Laryngoscope 2008: doi.org/10.1097/mlg.0b013e3181671b2d
- Sittel C et al., Prognostic value of laryngeal electromyography in vocal fold paralysis, Archives of Otolaryngology-Head and Neck Surgery 2001: doi.org/10.1001/archotol.127.2.155
- Smith LJ et al., Quantitative electromyography improves prediction in vocal fold paralysis, The Laryngoscope 2012: doi.org/10.1002/lary.21884
- Statham MM et al., Electromyographic laryngeal synkinesis alters prognosis in vocal fold paralysis, The Laryngoscope 2010: doi.org/10.1002/lary.20629
- Tseng JJ et al., Spontaneous Activity in Laryngeal Electromyography for Prognosis Prediction for Unilateral Vocal Fold Paralysis, Otolaryngology-Head and Neck Surgery 2025: doi.org/10.1002/ohn.1320
- Gyawali BR et al., A systematic review of state-of-the-art laryngeal electromyography in pediatric populations and meta-analysis of recovery prediction, International Journal of Pediatric Otorhinolaryngology 2026: doi.org/10.1016/j.ijporl.2026.112781
- Lin RJ et al., Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation, The Laryngoscope 2018: doi.org/10.1002/lary.27078
- Ingle JW et al., Prospective evaluation of the clinical utility of laryngeal electromyography, The Laryngoscope 2014: doi.org/10.1002/lary.24711
- Hu R et al., The Causes and Laryngeal Electromyography Characteristics of Unilateral Vocal Fold Paralysis, Journal of Voice 2023: doi.org/10.1016/j.jvoice.2020.11.022
- Ho GY et al., Inter-rater reliability of seven neurolaryngologists in laryngeal EMG signal interpretation, European Archives of Oto-Rhino-Laryngology 2019: doi.org/10.1007/s00405-019-05553-y
- Leclerc AA et al., Abnormal Laryngeal Electromyography Findings in Asymptomatic Adults Across the Age Spectrum, The Laryngoscope 2021: doi.org/10.1002/lary.29213
- Lin RJ et al., Technical Challenges for Laryngeal Electromyography, The Laryngoscope 2024: doi.org/10.1002/lary.31035
- Park HS et al., Clinical Usefulness of Ultrasonography-Guided Laryngeal Electromyography, Journal of Voice 2016: doi.org/10.1016/j.jvoice.2015.03.009
- Smith LJ and Munin MC, Utility of laryngeal electromyography for establishing prognosis and individualized treatment after laryngeal neuropathies, Muscle and Nerve 2025: doi.org/10.1002/mus.28207
- Quindlen CE et al., Safety of Laryngeal Electromyography and Repetitive Stimulation, Journal of Voice 2025: doi.org/10.1016/j.jvoice.2022.12.009
- Tarabichi S et al., Patient tolerance of laryngeal electromyography: a single-center study, Journal of Medicine and Life 2026: doi.org/10.25122/jml-2026-0007
- Volk GF et al., Vocal fold paresis: Medical specialists’ opinions on standard diagnostics and laryngeal findings, European Archives of Oto-Rhino-Laryngology 2018: doi.org/10.1007/s00405-018-5102-5
- Wu AP and Sulica L, Diagnosis of vocal fold paresis: current opinion and practice, The Laryngoscope 2015: doi.org/10.1002/lary.25004
- Ramirez-Ruiz RD et al., Current opinion on laryngeal electromyography, Acta Otorrinolaringologica Espanola 2024: doi.org/10.1016/j.otoeng.2023.07.001
- Halum SL et al., Laryngeal electromyography for adult unilateral vocal fold immobility: a survey of the American Broncho-Esophagological Association, Annals of Otology, Rhinology and Laryngology 2005: doi.org/10.1177/000348940511400602
- Kneisz L et al., Objectivation of laryngeal electromyography (LEMG) data: turn number vs. qualitative analysis, European Archives of Oto-Rhino-Laryngology 2020: doi.org/10.1007/s00405-020-05846-7
- Statham MM et al., Quantitative laryngeal electromyography: turns and amplitude analysis, The Laryngoscope 2010: doi.org/10.1002/lary.21046
- Data watch: most prognostic-accuracy figures come from studies published before 2023 and are flagged as most recent available data; the pooled adult estimate still rests on Rickert et al. 2012. NPV varies widely between sources (40.0% in Wang 2015, 55.6% in Rickert 2012, 60% in Grosheva 2008, 89.5% with quantitative LEMG in Smith 2012), reflecting different cohorts, timing and definitions of recovery, so no single NPV should be quoted as definitive. Figures attributed to Munin 2003, Koufman 2001, Heman-Ackah and Barr, Focquet et al. and Mau et al. are reported as cited inside the Neurolaryngology Study Group recommendations and the Korean guideline, not read from the original papers. A 2026 systematic review of spontaneous activity (Tarabichi et al., Current Health Sciences Journal) was reviewed but not used for figures because its pooled ranges did not match its own reported results. Survey data on adoption are small and dated (2005 to 2021 fieldwork) and should be refreshed.
Last updated: October 18, 2026. We update this roundup quarterly, and the next refresh is expected when the AANEM Practice Issue Review Panel next reviews its 2016 laryngeal EMG consensus statement.