Objective:
Laryngeal electromyography is a well-established diagnostic test of the larynx and a therapeutic option for Botox injections. We hypothesize it may also be useful for therapeutic injection of other materials. We report on 43 subjects who underwent injection using LEMG alone. We then used fiber-optic laryngoscopy to test the validity of this approach.

Material and methods
Between 2020 and 22025, 43 subjects prospectively received bilateral injections and 2 received unilateral injections, totaling 84 vocal fold injections. Ten patients had simultaneous Botox injections. The rest received PRP injections with LEMG control. There were no cases of complete paralysis. The reason for LEMG injections was patient preference, failure with fiberscope control, or the surgeon’s preference. All patients underwent fiberscope evaluation after LEMG injection to validate the procedure.

Results
Eighty-four vocal fold injections were done with LEMG control. Fiber-optic evaluation after injections showed extravasations of PRP or Restylane in 4 cases. There were three lamina propria injections. One patient needed urgent office removal of Restylane from the lamina propria. The rest (92%) had good augmentation with no extrusion or misplacement. The injection time was short and more comfortable than that of a two-team approach using indirect, fiber-optic-guided injection laryngoplasty.

Conclusion
Laryngeal electromyography-guided injection laryngoplasty can be performed using LEMG control. It has a 92% success rate. It is better tolerated than fiber scope guidance. This method is appropriate when two-team interventional injections are not available, when patient tolerance to fiberscope is poor, and when expertise in LEMG is available. The materials used for injection should be temporary, as extrusion and inadvertent injection into the lamina propria are possibilities.