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Crumley's Classification of Laryngeal Synkinesis: A Comparison of Laryngoscopy and Electromyography
Author(s) -
Foerster Gerhard,
Podema Rosa,
GuntinasLichius Orlando,
Crumley Roger L.,
Mueller Andreas H.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29275
Subject(s) - synkinesis , phonation , electromyography , larynx , medicine , laryngoscopy , audiology , vocal cord paralysis , paralysis , physical medicine and rehabilitation , surgery , intubation , pathology , alternative medicine , palsy
Objectives/Hypothesis Applying the principles of misdirected nerve regeneration to the larynx, Roger Crumley in 1989 coined the term laryngeal synkinesis (LS) which he later (2000) classified into 4 types (type I – good voice, type II – involuntary twitches and poor voice, type III – adduction during inspiration, type IV – abduction during phonation). Neurophysiological data were not available for all LS patients at that time. The current study was undertaken to utilize and test the Crumley classification for a clinical interrater comparison and, secondly, compare predicted with actual laryngeal electromyography (LEMG) results. Study Design Descriptive study. Methods Laryngoscopic and LEMG data of patients with unilateral vocal fold paralysis (VFP) of 6 months duration or longer were combined for retrospective evaluation. Forty‐five data sets were available for laryngoscopic classification by two local laryngologists and by Roger Crumley. Twenty‐three data sets with complete thyroarytenoid (TA) and posterior cricoarytenoid (PCA) – EMG data were used to compare predicted with actual LEMG results. Results Local laryngologists were able to classify 24 of 45, Crumley 30 of 45 cases into one of the 4 synkinesis types. There was substantial agreement between examiners (Cohens Kappa 0.66 [ P < .001]). Comparison of predicted and actual LEMG data showed only moderate agreement. EMG sykinesis rates were lower in TA than in PCA and highest in Crumley type I cases. Conclusion The Crumley classification is helpful in describing and understanding synkinesis. It does not always correlate predictably with actual LEMG data. A complete LEMG mapping of all intrinsic muscles may improve understanding of chronic VFP. Level of Evidence 4. Laryngoscope , 131:E1605–E1610, 2021