{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T04:28:51Z","timestamp":1782275331390,"version":"3.54.5"},"reference-count":49,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T00:00:00Z","timestamp":1588550400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Intraoperative neuromonitoring (IONM) techniques aim to identify and potentially prevent nerve injury during surgeries. Prior studies into the efficacy of recurrent laryngeal nerve (RLN) IONM convey mixed results, with some claiming equivalence between IONM and no monitoring at all. The goal of the current study was to compare <jats:italic>continuous<\/jats:italic> RLN monitoring using the laryngeal adductor reflex (LAR) to <jats:italic>intermittent<\/jats:italic> RLN monitoring (intermittent IONM) to determine whether continuous monitoring reduces the incidence of intraoperative RLN injury during neck endocrine surgeries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this observational, historical case\u2010control study, a historical cohort of patients monitored with intermittent\u2010IONM (group 1, n = 130) were compared to prospectively collected data from consecutive nerves\u2010at\u2010risk monitored continuously with the LAR (LAR\u2010CIONM, group 2, n = 205), at a single center by a single surgeon. The test benefit ratio and relative risk reduction (RRR) for LAR\u2010CIONM over intermittent IONM were calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>For group 1, nine nerves at risk exhibited intraoperative LOS with transient postoperative vocal fold (VF) hypomobility (n = 2) or immobility (VFI, n = 7). For group 2, two nerves at risk (0.98%) had sudden intraoperative LAR LOS following bipolar cautery, resulting in postoperative transient VFI (<jats:italic>P<\/jats:italic> = .004). In each group, there was one case of permanent postoperative VFI. The test benefit rate ratio for LAR\u2010CIONM demonstrated a dramatic effect at 5.23, with an RRR of 81.0%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>LAR\u2010CIONM significantly decreased rates of postoperative transient VF paralysis and paresis over intermittent IONM alone (<jats:italic>P<\/jats:italic> = .004). Surgeons should be aware of the benefits and limitations of intermittent IONM versus CIONM. Intermittent IONM, although useful in nerve mapping and intraoperative decision making, has minimal benefit for the <jats:italic>prevention<\/jats:italic> of nerve injury, whereas CIONM can potentially reduce nerve injury rates and improve patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>3 <jats:italic>Laryngoscope<\/jats:italic>, 131:230\u2013236, 2021<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.28710","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T13:29:56Z","timestamp":1588598996000},"page":"230-236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":35,"title":["Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery"],"prefix":"10.1002","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7129-7372","authenticated-orcid":false,"given":"Catherine 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