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Despite widespread use of intraoperative nerve monitoring (IONM) as an adjunct to visual identification of the recurrent laryngeal nerve (RLN), published studies have shown little or no benefit. No long-term studies exist detailing the effect of experience gained from IONM on the rate of RLN injury. The aim of this study was to evaluate the impact of IONM feedback on surgical outcomes over time at a single institution.

We conducted retrospective analysis of prospectively gathered data for 1,936 patients including 3,435 nerves at risk between March 2004 and September 2011. Each RLN was analyzed for the specific, unilateral operative procedure that placed the nerve at risk of injury. The primary outcome measures included temporary vocal cord palsy and permanent vocal cord paralysis or paresis as determined by intraoperative loss of RLN function and postoperative laryngoscopy. Additional …