RESUMEN
PURPOSE: This study evaluates expert opinion on laryngeal electromyography (LEMG). METHODS: A cross-sectional design was used to conduct an online survey of LEMG experts in 2021. They were questioned about the number LEMG performed annually, type of electrodes used, sector worked in, pain during the test, placement of the needle electrodes, interpretation of electrical muscle parameters, diagnosis of neuromuscular injury, prognostic sensitivity in vocal fold paralysis (VFP), laryngeal dystonia, tremor and synkinesis and quantifying LEMG. RESULTS: Thirty-seven professionals answered (23 Spanish and 14 from other countries), with a response rate of 21.56%. All physicians used LEMG. 91.9% had one- or two-years' experience and 56.8% performed 10-40 LEMG per year. 70.3% were otolaryngologists and 27%, neurologists. In 89.1% of cases, a team of electrodiagnostic physician and otolaryngologist performed LEMG. 91.3% of Spanish respondents worked in Public Health, 7.14% of other nationalities; 37.8% in a university department. Bipolar concentric needles electrodes were used by 45.9% and monopolar concentric by 40.5%. 57% professionals considered good patients' tolerance to the test. LEMG sensitivity was regarded as strong, median and interquartile range were 80.0 [60.0;90.0] to diagnose peripheral nerve injuries, less for other levels of lesions, and strong to evaluate prognosis, 70.0 [50.0;80.0]. Respondents believe locate the thyroarytenoid and the cricothyroid muscles with the needle, 80.0 [70.0;90.0], as opposed to 20.0 [0.00;60.0] the posterior cricoarytenoid. The interpretation of the electrical parts of the LEMG was strong, 80.0 [60.0;90.0]. LEMG identify movements disorders, 60.0 [20.0;80.0], and synkinesis, 70.0 [30.0;80.0]. The professionals prefer quantitative LEMG, 90.0 [60.0;90.0]. CONCLUSIONS: The experts surveyed consider LEMG that is well tolerated by patients. The insertional and spontaneous activity, recruitment and waveform morphology can be assessed easily. LEMG is mainly useful in the study of peripheral nerve injuries, and its value in VFP prognosis is considered strong.
RESUMEN
Introducción: La prevalencia de hipovitaminosis D es alta, afectando a jóvenes y adultos. Además de los trastornos esqueléticos originados por este déficit, se evidenció la presencia de otros trastornos, debido a la acción de la vitamina D en otros órganos y sistemas. La reducción de los niveles séricos de esta hormona se correlaciona con la presencia de un sindrome miopático que afecta a los músculos proximales de los miembros. Objetivo: Evaluar retrospectivamente los hallazgos electromiográficos de un grupo de pacientes que consultaron por debilidad muscular y/o déficit de fuerza proximal en quienes se descartaron otras causas de miopatía. Materiales y métodos: Se estudiaron 22 pacientes, con una edad media de 51 años (24-64), con un cuadro clínico compatible con miopatía, con hipovitaminosis D. Se descartaron otras causas de miopatía. Se analizaron los datos electromiográficos obtenidos durante el reposo y los hallazgos cuantitativos realizados en los músculos bíceps braquial y vasto interno en forma cruzada mediante el multianálisis de los Potenciales de unidad motora (PUM) durante el esfuerzo voluntario leve. Se compararon los siguientes parámetros: amplitudes, duraciones, número de fases y el índice "thickness" de los PUM de los pacientes evaluados, con los datos publicados por la literatura; se relacionó cada uno de esos parámetros con los niveles séricos de vitamina D. Resultados: En ninguno de los músculos evaluados se evidenció la presencia de actividad espontánea durante el reposo. Se halló una diferencia significativa (p<0.05) en todos los parámetros evaluados: amplitudes, duraciones, número de fases e índice "thickness". Ninguno de estos parámetros alterados fue correlacionado con los niveles séricos de vitamina D. Conclusión: La hipovitaminosis D se asocia con debilidad muscular proximal que se manifiesta en el examen físico neuromuscular y se confirma mediante el examen electrofisiológico utilizando el paradigma multi-MUAP de electromiografía cuantitativa. No se asocia con actividad espontánea en en reposo. Es de vital importancia su reconocimiento dado que se trata de un desorden reversible con la terapia adecuada
Introduction: the prevalence of Vitamin D deficiency is high, affecting young people and also adults. In addition to the skeletal disorders caused by this deficit, the presence of other disorders was evidenced, due to the action of Vitamin D in other organs and systems. The reduction of serum levels of this hormone correlates with the presence of a myopathic syndrome that affects the proximal muscles of the limbs. Objective: To retrospectively evaluate the electromyographic findings of a group of patients who consulted due to muscular weakness and / or proximal force deficit in whom other causes of myopathy were ruled out. Materials and methods: 22 patients were studied, with an average age of 51 years (24-64), with a clinical picture compatible with myopathy, with hypovitaminosis D. Other causes of myopathy were ruled out. We analyzed the electromyographic data obtained during rest and the quantitative findings made in the biceps brachialis and vastus medialis in a crossed way by means of the multianalysis of the Potentials of the motor unit (PUM) during the mild voluntary effort. The following parameters were compared: amplitudes, durations, number of phases and the thickness index of the PUM of the evaluated patients, with the data published by the literature; each of these parameters was related to serum vitamin D levels. Results: In none of the evaluated muscles was evidentiated the presence of spontaneous activity during rest. A significant difference (p <0.05) was found in all parameters evaluated: amplitudes, durations, number of phases and thickness index. None of these altered parameters was correlated with serum vitamin D levels. Conclusion: Hypovitaminosis D is associated with proximal muscle weakness that manifests itself in the neuromuscular physical examination and is confirmed by electrophysiological examination using the multi-MUAP quantitative electromyography paradigm. It is not associated with spontaneous activity at rest. Its recognition is of vital importance given that it is a reversible disorder with the appropriate therapy