Electromyography in near-total laryngectomy

Objective: To investigate the dynamics of speech shunt muscle in patients with Pearson near-total laryngectomy by needle electromyography and correlation of ability to activate shunt muscle with speech production. Design and Settings: Prospective study of patients with near-total laryngectomy at 2 hospital-based academic tertiary care centers. Participants and Intervention: Fourteen patients with near-total laryngectomy were subjected to percutaneous needle electromyographic study of the shunt muscle. Main Outcome Measures: Speech ability, electromyographic evidence of viable muscle in shunt wall, and ability to activate shunt muscle were recorded. Results: Twelve of 14 patients had good speech; 11 had evidence of viable shunt muscle; and 9 were able to activate muscle by phonation, swallowing, or deep breathing, indicating preserved innervation. Six of the 12 patients with speech ability and i of the 2 patients without speech ability were able to recruit motor units during attempted phonation. Conclusions: Electromyography demonstrated viable muscle with retained innervation in 64% of the patients with near-total laryngectomy, proving its 'dynamic' nature. However, the usefulness of shunt muscle activation in speech and prevention of aspiration needs further confirmation.