Laryngeal Nerve Monitoring Use: An Emerging Consensus?

Objective There is continued debate over the value of laryngeal nerve monitoring (LNM) during thyroidectomy. Previous studies have suggested that utilization of electromyographic endotracheal tubes for neuromonitoring is limited. We queried head and neck surgeons regarding their attitudes toward LNM. Method An anonymous, internet‐based survey of the members of the American Head and Neck Society was performed. Information was collected on participants’ training history, practice setting, years of experience, and annual volume of thyroid and parathyroid surgeries. Participants’ use of LNM and their beliefs regarding possible benefits were assessed. Results A total of 170 surveys were completed (18% response rate). Of respondents, 65% use LNM in at least some thyroid and parathyroid cases, 37% always, and 29% sometimes. Utilization was associated with the belief that LNM reduces the risk of recurrent nerve injury ( P <. 001). However, the most commonly cited reasons for LNM use were “medical‐legal protection” and “increased confidence.” Comparing otolaryngologists to general surgeons, 43% vs 17% ( P =. 016) always use LNM, 25% vs 36% sometimes, and 30% vs 47% never use monitoring. Younger surgeons were more likely to use LNM. No association was found between LNM utilization and case volume or practice type. Conclusion Currently, no consensus exists regarding the use of LNM during thyroid and parathyroid surgery. The results of this survey suggest that LNM use has become more widespread. Irrespective of the reasons surgeons are adopting LNM, if this trend continues LNM may eventually become routine practice among head and neck surgeons.