The value of intraoperative neuromonitoring and neurostimulation in thyroid surgery: A single-center retrospective analysis and prospective follow-up

This study aims to determine the accuracy of neurostimulation with laryngeal palpation (NSLP) and intermittent intraoperative neuromonitoring (I-IONM) to predict the postoperative function of the recurrent laryngeal nerve during thyroid surgery and to follow up patients with vocal fold paralysis (VFP). This was a historical single-center retrospective cohort study with a prospective follow-up. A total of 1471 patients (2408 nerves at risk) comparing I-IONM and NSLP for patients undergoing hemi-, total, or completion thyroidectomy from January 2009 to January 2024. The I-IONM group included 810 patients with 1327 nerves at risk, and the NSLP group included 661 patients with 1081 nerves at risk. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy were calculated, with nerve palsy as the target outcome. Transient VFP occurred in 1.1% (IONM) versus 1.9% (NSLP; P = .163) and permanent VFP occurred in 0.5% and 0.8% of patients respectively (P = .763). The presence or absence of laryngeal twitch in the NSLP group (P = .004) and acoustic response to electrical stimulation in the IONM group (P = .001) were significantly correlated with postoperative vocal fold function at the end of surgery. Both methods showed high NPV (IONM, 99.5%; NSLP, 99.2%). Therefore, NSLP is a safe and reliable alternative to IONM for intraoperative recurrent laryngeal nerve monitoring during thyroidectomy. The high NPV supports its utility in predicting normal postoperative vocal fold function, particularly when IONM is unavailable or impractical.