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Objective: Endotracheal tube (ETT) surface electrodes are used to monitor the vagus nerve (VN), recurrent laryngeal nerve (RLN), and external branch of the superior laryngeal nerve (EBSLN) during thyroid and parathyroid surgery. Alternative nerve monitoring methods are desirable when intubation under general anesthesia is not desirable or possible. In this pilot study, we compared the performance of standard ETT electrodes to four different noninvasive cutaneous recording electrode types (two adhesive electrodes and two needle electrodes) in three different orientations. Methods: The VN was stimulated directly during thyroid and parathyroid surgery using a Prass stimulator probe. Electromyographic (EMG) responses for each patient were recorded using an ETT plus one of the following four cutaneous electrode types: large‐foot adhesive, small‐foot adhesive, long‐needle and short‐needle. Each of the four electrode types was placed in three orientations: (1) bilateral, (2) ipsilateral mediolateral, and (3) ipsilateral craniocaudal. Results: Four surgical cases were utilized for data collection with the repetitive measures obtained in each subject. Bilateral electrode orientation was superior to ipsilateral craniocaudal and ipsilateral mediolateral orientations. Regardless of electrodes type, all amplitudes in the bilateral orientation were >100 μV. When placed bilaterally, the small‐foot adhesive and the long‐needle electrodes obtained the highest EMG amplitudes as a percentage of ETT amplitudes. Conclusion: Cutaneous electrodes could potentially be used to monitor the VN during thyroid and parathyroid procedures. Different electrode types vary in their ability to record amplitudes and latencies. Bilateral orientation improves EMG responses in all electrode types. Additional validation of cutaneous electrodes as an alternative noninvasive method to monitor the VN is needed. [ABSTRACT FROM AUTHOR]

B Dear Editor: b Advanced thyroid cancers may invade recurrent laryngeal nerve (RLN) through direct tumor extension or lymph node metastasis, resulting in vocal fold paralysis (VFP) which impacts patient's quality of life, affects the resectability when operating on the contralateral (functional) side due to the significant risk for bilateral VFP during surgery and the potential need for tracheotomy, and significantly impacts the surgical strategy.[1],[2] Many patients will be understandably hesitant to undergo surgery that involves permanent tracheotomy.[3] Both unilateral or bilateral VFP have a negative impact on a patient's quality of life and general health.[4],[5] While preoperative VFP is highly suggestive of RLN invasion, normal voice or laryngeal exam does not exclude RLN invasion at surgery. I BRAF SP V600E sp i mutations were detected in all seven patients (100%), I TERT i promoter mutations were detected in four patients (57.1%), I PIK3CA i mutations in two patients (28.6%), and I TP53 i mutations in two patients (28.6%), Supplementary Table S1. Overall, the median number of cycles of all neoadjuvant therapy received per patient regardless of therapy type was 4 cycles/patient. [Extracted from the article]

Background: Understanding the patterns of IONM use and training among resident otolaryngologists is essential to ensure that the IONM skills and knowledge gained in residency are optimized for successful future practice of IONM. Method: An electronic survey was distributed to US‐based OHNS residents. Questions evaluated resident experience, implementation, knowledge and understanding of IONM for endocrine surgeries. Results: One hundred and seven OHNS residents participated, spanning all training levels and US geographic locations. The majority of residents received no didactic teaching on IONM (74.5%) nor had a clear troubleshooting algorithm in the event of a loss of signal (69.8%). The majority of residents were uncertain regarding the advantages/disadvantages of continuous versus intermittent IONM. Conclusion: The knowledge gap found in our survey study suggests that greater teaching of IONM principles for endocrine head and neck surgeries in OHNS residency programs would help to ensure successful utilization in future practice. [ABSTRACT FROM AUTHOR]