A systematic review of state-of-the-art Laryngeal Electromyography in pediatric populations and meta-analysis of recovery prediction in vocal cord paralysis.

OBJECTIVES

To provide a comprehensive evaluation of state-of-art Laryngeal Electromyography (LEMG) in pediatric population and quantitatively assess its prognostic utility in vocal cord paralysis (VCP).

METHODS

The systematic review and meta-analysis were carried out and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across PubMed, Scopus, and Google Scholar. Eligible studies included case reports, case series, and observational studies. Data were extracted qualitatively and pooled using a random-effects model to evaluate the prognostic utility of LEMG in predicting VCP recovery.

RESULTS

A total of 33 studies were included in the qualitative analysis, and five studies for meta-analysis. The mean age of patients in studies included for qualitative analysis was 6.77 ± 5.73 years, with an age range from day 1 of life to 18 years. In contrast, the studies included in the meta-analysis enrolled children ranging from day 1 of life to 14 years, with a mean age of 2.01 ± 1.03 years. A random-effects meta-analysis of sensitivity of three studies yielded a pooled sensitivity of 82% (95% CI: 51-96%). A meta-analysis of Positive Predictive Value (PPV) of two studies, showed a pooled PPV of 75.0% (95% CI: 27.0% to 96.0%). Cox Proportional Hazards regression analysis showed that patients with Motor Unit Action Potential (MUAP) present had 5.56 times higher likelihood of recovery than those without MUAP (Hazard Ratio = 5.56, 95% CI: 1.65-18.71, p = 0.00558). The Kaplan Meier (KM) curve analysis demonstrated patients with MUAP exhibited higher chances of recovery over time compared to those without MUAP (p = 0.00094).

CONCLUSION

LEMG in pediatric laryngology serves a valuable diagnostic, therapeutic, and prognostic adjunct with diverse applications. It shows moderate accuracy in predicting favorable recovery in cases of VCP when normal MUAPs are present.