Neuromonitoring of the laryngeal nerves in thyroid surgery: a critical appraisal of the literature

Eur Arch Otorhinolaryngol. 2013 Sep;270(9):2383-95. doi: 10.1007/s00405-013-2558-1. Epub 2013 May 18.


One of the most significant complication of thyroid surgery is injury of the recurrent laryngeal nerve. Injury of the external branch of the superior laryngeal nerve is a less obvious but occasionally significant problem. Recently, neuromonitoring during thyroidectomy has received considerable attention because of literature encouraging its use, but there is no consensus about its advantages and utility. A critical assessment of the literature on neuromonitoring was conducted in order to define its effectiveness, safety, cost-effectiveness and medical-legal impact. Available data does not show results superior to those obtained by traditional anatomical methods of nerve identification during thyroid surgery. Data about cost-effectiveness is scarce. The literature shows inconsistencies in methodology, patient selection and randomization in various published studies which may confound the conclusions of individual investigations. The current recommendation for use in "high risk" patients should be assessed because definition heterogeneity makes identification of these patients difficult. As routine use of neuromonitoring varies according to geography, its use should not be considered to be the standard of care.

Publication types

  • Review

MeSH terms

  • Electromyography / methods
  • Humans
  • Intraoperative Complications / prevention & control*
  • Intraoperative Neurophysiological Monitoring* / methods
  • Laryngeal Nerve Injuries / etiology
  • Laryngeal Nerve Injuries / prevention & control*
  • Thyroid Gland / surgery*
  • Thyroidectomy / adverse effects*
  • Thyroidectomy / methods
  • Vocal Cord Paralysis / etiology
  • Vocal Cord Paralysis / prevention & control