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Invited Commentary
December 2016

Intraoperative Nerve Monitoring During Thyroidectomy—More Complex Than Cost Alone

Author Affiliations
  • 1Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
  • 3Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2016;142(12):1206-1207. doi:10.1001/jamaoto.2016.3116

Injury to the recurrent laryngeal nerve (RLN) is one of the major complications of thyroid surgery. Whether unilateral or bilateral, RLN injury is significantly debilitating to the patient and reduces quality of life, daily voice function, and airway stability. A key component to thyroid surgery is identifying and preserving the RLN, but intraoperative nerve monitoring (IONM) during thyroid surgery has become a controversial issue.

Two generalized IONM techniques are used to monitor neural electrical activity: active vocal fold monitoring via the endotracheal tube and passive monitoring via direct nerve contact stimulation. Although nerve monitoring has a long history in all specialties, its use in thyroid surgery surged in popularity in the last few decades. Multiple studies have shown conflicting data regarding benefits of nerve monitoring during thyroid surgery. Two large meta-analyses failed to show that use of IONM technology is superior to direct visualization alone in decreasing rates of injury to the RLN.1,2 This finding has left many to wonder if IONM is truly the standard of care or simply a technology looking for another home and lacking scientific merit.

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