Meta-analysis finds Laryngeal EMG moderately predicts vocal cord paralysis recovery in children
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Key Takeaway
Consider LEMG as a moderate predictor of VCP recovery in children, but interpret with caution due to wide confidence intervals.
This systematic review and meta-analysis evaluated the prognostic utility of Laryngeal Electromyography (LEMG) in predicting recovery from vocal cord paralysis (VCP) in pediatric patients. The qualitative analysis included 33 studies (day 1 of life to 18 years), while the meta-analysis included 5 studies (day 1 to 14 years). The primary outcome was the prognostic utility of LEMG in predicting VCP recovery.
Key findings from the meta-analysis showed a pooled sensitivity of 82% (95% CI: 51-96%) and a pooled positive predictive value of 75.0% (95% CI: 27.0% to 96.0%) for LEMG in predicting recovery. The presence of motor unit action potentials (MUAPs) was associated with a higher likelihood of recovery (hazard ratio 5.56, 95% CI: 1.65-18.71, p = 0.00558), and Kaplan-Meier curves showed significantly higher recovery rates over time in patients with MUAPs (p = 0.00094).
Limitations include wide confidence intervals for pooled estimates, a limited number of studies in the meta-analysis, and the observational nature of included studies, which precludes causal inference. The authors did not report specific limitations, but the certainty of evidence is moderate at best.
Clinically, LEMG may offer moderate accuracy in predicting favorable recovery when normal MUAPs are present, but the wide confidence intervals and small sample size suggest cautious interpretation. Further validation in larger, prospective studies is needed before routine clinical use can be recommended.
View Original Abstract ↓
OBJECTIVES: To provide a comprehensive evaluation of state-of-art Laryngeal Electromyography (LEMG) in pediatric population and quantitatively assess its prognostic utility in vocal cord paralysis (VCP).
METHODS: The systematic review and meta-analysis were carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across PubMed, Scopus, and Google Scholar. Eligible studies included case reports, case series, and observational studies. Data were extracted qualitatively and pooled using a random-effects model to evaluate the prognostic utility of LEMG in predicting VCP recovery.
RESULTS: A total of 33 studies were included in the qualitative analysis, and five studies for meta-analysis. The mean age of patients in studies included for qualitative analysis was 6.77 ± 5.73 years, with an age range from day 1 of life to 18 years. In contrast, the studies included in the meta-analysis enrolled children ranging from day 1 of life to 14 years, with a mean age of 2.01 ± 1.03 years. A random-effects meta-analysis of sensitivity of three studies yielded a pooled sensitivity of 82% (95% CI: 51-96%). A meta-analysis of Positive Predictive Value (PPV) of two studies, showed a pooled PPV of 75.0% (95% CI: 27.0% to 96.0%). Cox Proportional Hazards regression analysis showed that patients with Motor Unit Action Potential (MUAP) present had 5.56 times higher likelihood of recovery than those without MUAP (Hazard Ratio = 5.56, 95% CI: 1.65-18.71, p = 0.00558). The Kaplan Meier (KM) curve analysis demonstrated patients with MUAP exhibited higher chances of recovery over time compared to those without MUAP (p = 0.00094).
CONCLUSION: LEMG in pediatric laryngology serves a valuable diagnostic, therapeutic, and prognostic adjunct with diverse applications. It shows moderate accuracy in predicting favorable recovery in cases of VCP when normal MUAPs are present.
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