In Reply I would like to thank Tang and coauthors1 for their comments on our recent article2 and for giving me the opportunity to further clarify our technique.
First, they1 express doubt about the usefulness of laryngeal electromyography (LEMG) guidance in a paralyzed vocal fold with absolutely no electrical activity. Actually, this condition rarely occurs because of the strong likelihood of laryngeal reinnervation after recurrent laryngeal nerve injury.3 In an online video published with our article, we show a successful injection in this type of case.2 We also introduced an “airway signal,” characterized with regular waves on LEMG, indicating that the LEMG needle is in the laryngeal airway. During the procedure, if we confirmed that the needle tip was between the airway and thyroid cartilage, a silent electrical signal could also be used as other abnormal signals to locate the paralyzed thyroarytenoid muscle.
Wang C. The Effectiveness of Using Laryngeal Electromyography Guidelines for Injection Augmentation—Reply. JAMA Otolaryngol Head Neck Surg. 2015;141(11):1030–1031. doi:10.1001/jamaoto.2015.2416
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