Clin Exp Otorhinolaryngol.  2020 Aug;13(3):291-298. 10.21053/ceo.2019.01249.

Application of Novel Intraoperative Neuromonitoring System Using an Endotracheal Tube With Pressure Sensor during Thyroid Surgery: A Porcine Model Study

  • 1Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Pusan National University and Medical Research Institute, Pusan National University Hospital, Busan, Korea
  • 3Department of Biomedical Engineering, Pusan National University Hospital, Busan, Korea


. The loss of signal during intraoperative neuromonitoring (IONM) using electromyography (EMG) in thyroidectomy is one of the biggest problems. We have developed a novel IONM system with an endotracheal tube (ETT) with an attached pressure sensor instead of EMG to detect laryngeal twitching. The aim of the present study was to investigate the feasibility and reliability of this novel IONM system using an ETT with pressure sensor during thyroidectomy in a porcine model.
. We developed an ETT-attached pressure sensor that uses the piezoelectric effect to measure laryngeal muscle twitching. Stimulus thresholds, amplitude, and latency of laryngeal twitching evaluated using the pressure sensor were compared to those measured using transcartilage needle EMG. The measured amplitude changes by EMG and the pressure sensor during recurrent laryngeal nerve (RLN) traction injury were compared.
. No significant differences in stimulus threshold intensity between EMG and the pressure sensor were observed. The EMG amplitude detected at 0.3 mA, increased with increasing stimulus intensity. When the stimulus was more than 1.0 mA, the amplitude showed a plateau. In a RLN traction injury experiment, the EMG amplitude did not recover even 20 minutes after stopping RLN traction. However, the pressure sensor showed a mostly recovery.
. The change in amplitude due to stimulation of the pressure sensor showed a pattern similar to EMG. Pressure sensors can be feasibly and reliably used for RLN traction injury prediction, RLN identification, and preservation through the detection of laryngeal muscle twitching. Our novel IONM system that uses an ETT with an attached pressure sensor to measure the change of surface pressure can be an alternative to EMG in the future.


Intraoperative Neurophysiological Monitoring; Pressure Sensor; Electromyography; Recurrent Laryngeal Nerve; Thyroidectomy
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