Prognostic Value of Spontaneous Activity on Laryngeal Electromyography for Recovery of Vocal Fold Motion: A Systematic Review of Observational Studies.

Abstract

Background-Vocal fold motion impairment resulting from laryngeal nerve injury poses a recurring prognostic dilemma in clinical practice. While laryngeal electromyography (LEMG) has been increasingly adopted as an objective tool for neuromuscular assessment, the specific prognostic value of spontaneous activity for predicting recovery of vocal fold motion remains incompletely defined. This systematic review aimed to evaluate the relationship between the presence of spontaneous activity on LEMG and subsequent vocal fold motion recovery across observational studies. Methods-A systematic search of MEDLINE (via PubMed), Embase, Scopus and the Cochrane Library databases was conducted in accordance with PRISMA guidelines, covering publications up to March 2026. Results-Across the included studies, the presence of spontaneous activity on LEMG-particularly fibrillation potentials-was consistently associated with poor recovery of vocal fold motion. Patients demonstrating active denervation potentials showed significantly lower rates of meaningful functional recovery compared to those in whom spontaneous activity was absent. This association held across multiple etiological subgroups, including post-surgical and idiopathic cases, though the strength of the relationship varied with the timing of LEMG relative to injury onset and the duration of follow-up. Conclusions-Spontaneous activity on LEMG represents a clinically meaningful predictor of unfavorable prognosis for vocal fold motion recovery. Standardization of LEMG protocols and reporting criteria across future studies remains essential to strengthen the evidence base in this field.