Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns

Abstract

Introduction: Intraoperative nerve monitoring is used in otolaryngology to assist in identification of nerves at risk. It is hoped that this will lead to lower rates of nerve injury. The objective of this study was to quantify the use of monitoring technology in current clinical practice. Method: An electronic survey was distributed to 376 registered fellows of the Australian Society of Head and Neck Surgery. Results: One-hundred and twenty-five responses were obtained. The majority of respondents report using monitoring at least some of the time during thyroid, parotid, and mastoid surgery (80%, 87%, and 73% respectively). Predictors of use include experience with intraoperative monitoring during training, and high caseloads in parotid surgery. Practice setting did not predict use. Conclusion: Despite equivocal evidence that intraoperative nerve monitoring is associated with a reduction in nerve injuries, this study demonstrates that the technology is widely used amongst otolaryngologists.

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Flukes, S. , Ling, S. , Leahy, T. and Sader, C. (2013) Intraoperative Nerve Monitoring in Otolaryngology: A Survey of Clinical Practice Patterns. International Journal of Otolaryngology and Head & Neck Surgery, 2, 21-26. doi: 10.4236/ijohns.2013.21007.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] J. P. Jeannon, A. A. Orabi, G. A. Bruch, H. A. Abdalsalam and R. Simo, “Diagnosis of Recurrent Laryngeal Nerve Palsy after Thyroidectomy: A Systematic Review,” International Journal of Clinical Practice, Vol. 63, No. 4, 2009, pp. 624-629. doi:10.1111/j.1742-1241.2008.01875.x
[2] G. R. Jatzko, P. H. Lisborg, M. G. Muller and V. M. Wette, “Recurrent Nerve Palsy after Thyroid Operations—Principal Nerve Identification and a Literature Review,” Surgery, Vol. 115, No. 2, 1994, pp. 139-144.
[3] J. H. Lefevre, C. Tresallet, L. Leenhardt, C. Jublanc, J. P. Chigot and F. Menegaux, “Reoperative Surgery for Thyroid Disease,” Langenbeck’s Archives of Surgery, Vol. 392, No. 6, 2007, pp. 685-691. doi:10.1007/s00423-007-0201-6
[4] H. Dralle, et al., “Risk Factors of Paralysis and Functional Outcome after Recurrent Laryngeal Nerve Monitoring in Thyroid Surgery,” Surgery, Vol. 136, No. 6, 2004, pp. 1310-1322. doi:10.1016/j.surg.2004.07.018
[5] W. F. Chan, B. H. Lang and C. Y. Lo, “The Role of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve during Thyroidectomy: A Comparative Study on 1000 Nerves at Risk,” Surgery, Vol. 140, No. 6, 2006, pp. 866-872. doi:10.1016/j.surg.2006.07.017
[6] M. Barczynski, A. Konturek and S. Cichon, “Randomized Clinical Trial of Visualization versus Neuromonitoring of Recurrent Laryngeal Nerves during Thyroidectomy,” British Journal of Surgery, Vol. 96, No. 3, 2009, pp. 240-246. doi:10.1002/bjs.6417
[7] T. S. Higgins, et al., “Recurrent Laryngeal Nerve Monitoring versus Identification Alone on Post-Thyroidectomy True Vocal Fold Palsy: A Meta-Analysis,” Laryngoscope, Vol. 121, No. 5, 2011, pp. 1009-1017. doi:10.1002/lary.21578
[8] E. L. Nilssen and P. J. Wormald, “Facial Nerve Palsy in Mastoid Surgery,” The Journal of Laryngology & Otology, Vol. 111, No. 2, 1997, pp. 113-116. doi:10.1017/S0022215100136618
[9] J. D. Green Jr., C. Shelton and D. E. Brackmann, “Iatrogenic Facial Nerve Injury during Otologic Surgery,” Laryngoscope, Vol. 104, No. 8, 1994, pp. 922-926. doi:10.1288/00005537-199408000-00002
[10] J. S. Greenberg, S. Manolidis, M. G. Stewart and J. B. Kahn, “Facial Nerve Monitoring in Chronic Ear Surgery: US Practice Patterns,” Otolaryngology—Head and Neck Surgery, Vol. 126, No. 2, 2002, pp. 108-114. doi:10.1067/mhn.2002.121861
[11] S. A. Nouraei, et al., “Analysis of Complications Following Surgical Treatment of Benign Parotid Disease,” ANZ Journal of Surgery, Vol. 78, No. 3, 2008, pp. 134-138. doi:10.1111/j.1445-2197.2007.04388.x
[12] N. Klintworth, J. Zenk, M. Koch and H. Iro, “Postoperative Complications after Extracapsular Dissection of Benign Parotid Lesions with Particular Reference to Facial Nerve Function,” Laryngoscope, Vol. 120, No. 3, 2010, pp. 484-490. doi:10.1002/lary.20801
[13] K. A. Kern, “Medicolegal Analysis of Errors in Diagnosis and Treatment of Surgical Endocrine Disease,” Surgery, Vol. 114, No. 6, 1993, pp. 1167-1173.
[14] S. S. Abadin, E. L. Kaplan and P. Angelos, “Malpractice Litigation after Thyroid Surgery: The Role of Recurrent Laryngeal Nerve Injuries, 1989-2009,” Surgery, Vol. 148, No. 4, 2010, pp. 718-722. doi:10.1016/j.surg.2010.07.019
[15] C. Hopkins, S. Khemani, R. M. Terry and D. Golding-Wood, “How We Do It: Nerve Monitoring in ENT Surgery: Current UK Practice,” Clinical Otolaryngology, Vol. 30, No. 2, 2005, pp. 195-198. doi:10.1111/j.1365-2273.2004.00933.x
[16] T. R. Lowry, T. J. Gal and J. A. Brennan, “Patterns of Use of Facial Nerve Monitoring during Parotid Gland Surgery,” Otolaryngology—Head and Neck Surgery, Vol. 133, No. 3, 2005, pp. 313-318. doi:10.1016/j.otohns.2005.03.010
[17] S. K. Horne, T. J. Gal and J. A. Brennan, “Prevalence and Patterns of Intraoperative Nerve Monitoring for Thyroidectomy,” Otolaryngology—Head and Neck Surgery, Vol. 136, No. 6, 2007, pp. 952-956. doi:10.1016/j.otohns.2007.02.011
[18] C. Sturgeon, T. Sturgeon and P. Angelos, “Neuromonitoring in Thyroid Surgery: Attitudes, Usage Patterns, and Predictors of Use among Endocrine Surgeons,” World Journal of Surgery, Vol. 33, No. 3, 2009, pp. 417-425. doi:10.1007/s00268-008-9724-4
[19] T. Friedrich, et al., “[Intraoperative Electrophysiological Monitoring of the Recurrent Laryngeal Nerve in Thyroid Gland Surgery—A Prospective Study],” Zentralbl Chir, Vol. 127, No. 5, 2002, pp. 414-420. doi:10.1055/s-2002-31983
[20] M. L. Robertson, D. L. Steward, J. L. Gluckman and J. Welge, “Continuous Laryngeal Nerve Integrity Monitoring during Thyroidectomy: Does It Reduce Risk of Injury?” Otolaryngology—Head and Neck Surgery, Vol. 131, No. 5, 2004, pp. 596-600. doi:10.1016/j.otohns.2004.05.030
[21] R. L. Witt, “Recurrent Laryngeal Nerve Electrophysiologic Monitoring in Thyroid Surgery: The Standard of Care?” Journal of Voice, Vol. 19, No. 3, 2005, pp. 497-500. doi:10.1016/j.jvoice.2004.05.001
[22] M. Shindo and N. N. Chheda, “Incidence of Vocal Cord Paralysis with and without Recurrent Laryngeal Nerve Monitoring during Thyroidectomy,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 133, No. 5, 2007, pp. 481-485. doi:10.1001/archotol.133.5.481
[23] S. Sari, et al., “Evaluation of Recurrent Laryngeal Nerve Monitoring in Thyroid Surgery,” International Journal of Surgery, Vol. 8, No. 6, 2010, pp. 474-478. doi:10.1016/j.ijsu.2010.06.009
[24] M. Makeieff, et al., “Continuous Facial Nerve Monitoring during Pleomorphic Adenoma Recurrence Surgery,” Laryngoscope, Vol. 115, No. 7, 2005, pp. 1310-1314. doi:10.1097/01.MLG.0000166697.48868.8C
[25] J. E. Terrell, et al., “Clinical Outcome of Continuous Facial Nerve Monitoring during Primary Parotidectomy,” Archives of Otolaryngology—Head and Neck Surgery, Vol. 123, No. 10, 1997, pp. 1081-1087. doi:10.1001/archotol.1997.01900100055008
[26] J. Reilly and D. Myssiorek, “Facial Nerve Stimulation and Postparotidectomy Facial Paresis,” Otolaryngology— Head and Neck Surgery, Vol. 128, No. 4, 2003, pp. 530-533. doi:10.1016/S0194-5998(03)00089-5
[27] H. Silverstein, S. I. Rosenberg, J. Flanzer and M. D. Seidman, “Intraoperative Facial Nerve Monitoring in Acoustic Neuroma Surgery,” American Journal of Otolaryngology, Vol. 14, No. 6, 1993, pp. 524-532.
[28] R. S. Noss, A. K. Lalwani and C. D. Yingling, “Facial Nerve Monitoring in Middle Ear and Mastoid Surgery,” Laryngoscope, Vol. 111, No. 5, 2001, pp. 831-836. doi:10.1097/00005537-200105000-00014
[29] A. Haenggeli, M. Richter, W. Lehmann and P. Dulguerov, “A Complication of Intraoperative Facial Nerve Monitoring: Facial Skin Burns,” American Journal of Otolaryngology, Vol. 20, No. 5, 1999, pp. 679-682.
[30] J. Brennan, E. J. Moore and K. J. Shuler, “Prospective Analysis of the Efficacy of Continuous Intraoperative Nerve Monitoring during Thyroidectomy, Parathyroidectomy, and Parotidectomy,” Otolaryngology—Head and Neck Surgery, Vol. 124, No. 5, 2001, pp. 537-543. doi:10.1067/mhn.2001.115402
[31] P. Angelos, “Recurrent Laryngeal Nerve Monitoring: State of the Art, Ethical and Legal Issues,” Surgical Clinics of North America, Vol. 89, No. 5, 2009, pp. 1157-1169. doi:10.1016/j.suc.2009.06.010

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