Laryngeal Electromyography: Clinical Roles and Recent Advances in Neurolaryngology

Laryngeal electromyography (LEMG) is a central tool in neurolaryngology for evaluating the pathophysiology and prognosis of laryngeal movement disorders by directly recording intrinsic laryngeal muscle activity. Building on the neurolaryngology framework and recent international guidelines, this review summarizes current evidence on the principles, techniques, interpretation, and clinical applications of LEMG. Basic laryngeal neuroanatomy and electromyographic features that distinguish neurogenic from myopathic lesions are outlined, with emphasis on the small motor units of laryngeal muscles and the need for side-to-side and serial comparison. Practical aspects of equipment, electrode selection, team composition, patient preparation, and standardized percutaneous and transoral approaches are described with attention to safety and reproducibility. Interpretive criteria for insertional and spontaneous activity, motor unit action potentials, recruitment patterns, synkinesis, and Seddon’s nerve injury classification are linked to prognostic categories across the time course of recurrent laryngeal nerve damage. Key clinical indications and emerging technologies including quantitative LEMG, laryngeal magnetic stimulation, functional electrostimulation, laryngeal pacing, and reflex-based nerve conduction testing are discussed as tools to enhance individualized decision-making in laryngeal neuropathies.