Recurrent laryngeal nerve (RLN) paralysis is a distressing complication of thyroidectomy, and many methods have been investigated for prevention.

The aim of our study is to investigate to what extent intraoperative neuromonitoring (IONM) predicts postoperative RLN paralysis and what factors may be causing it.

Patients who underwent thyroidectomy in our clinic between January 2014 and December 2020 were included. Patient diagnoses, demographic characteristics, laboratory and imaging results, surgical information, and IONM results were evaluated.

Data from 287 patients and 523 RLNs were evaluated. Twenty-two (4.2%) of the RLNs were paralytic. The rate of paralysis was significantly higher in total thyroidectomies than in lobectomies (p = 0.046), permanent paralysis rate was higher in left RLNs. Malignancy was statistically associated with permanent paralysis (p = 0.017). The rate of overall and permanent paralysis was higher in patients with negative results of first, second response, first, and second laryngeal twitch examinations. The means of the first and second responses of the paralyzed RLNs were lower (p = 0.016, p < 0.01, respectively). The sensitivity of the IONM increased when the new thresholds of the first and second responses were determined to be 155 and 170 µv, respectively, by ROC analysis.

This study demonstrates that voltage variation and magnitude obtained from IONM can be predictive and sensitivity can be increased by using a threshold higher than 100 µV and patients in this range may be at risk for RLN paralysis. Our results may guide future studies of IONM and risk scoring systems to be developed for RLN paralysis.

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by institutional ethics committee and individual consent for this retrospective analysis was waived.

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

All the authors were involved in design, material preparation and data collection. BY, ÖB, GS, İA and MHK were involved in study conception. The study was supervised by ÖB, GS, EÇ, EÇT and MHK. Data analysis was completed by SAT and BY. Investigation was accomplished by MK, BU and İA. BU took part in project administration, MK and EÇ took part in methodology. GS and SAT conducted the validation process. The first draft of the manuscript was completed by BY. The review and editing process of the final manuscript was performed by ÖB. All authors commented on previous versions of the manuscript, read and approved the final manuscript.

Data will be available upon request to the corresponding author.

Editor-in-Chief: Geraldo Pereira Jotz.

Received: 07 December 2024

Accepted: 11 June 2025

Article published online:
11 March 2026

© 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Başak Yalçıner, Ömer Bayır, Muhammed Kızılgül, Bekir Uçan, Güleser Saylam, Emel Çadallı Tatar, Erman Çakal, Sibel Alicura Tokgöz, İlker Akyıldız, Mehmet Hakan Korkmaz. Effect of Intraoperative Nerve Monitorization on Predicting Vocal Cord Paralysis in Thyroid Surgery. Int Arch Otorhinolaryngol 2026; 30: s00451810079.
DOI: 10.1055/s-0045-1810079