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Several recent studies have confirmed that LEMG is a reliable predictor of persistent palsy (no recovery of physiological vocal fold movements) in patients with acute unilateral or bilateral VFP [7, 8]. Once the patient is classified to have a bad prognosis by clinical examination and by the LEMG results, definitive treatment of the VFP can be planned [9, 10]. In contrast, it is often said that LEMG is not a reliable predictor of recovery. In this context, an actual meta-analysis of an expert panel of the AANEM is of interest, as it has identified LEMG parameters that might also help to predict recovery [3]. First of all, this meta-analysis has revealed that LEMG has its highest diagnostic value in patients with VFP that is more than 4 weeks and less than 6 months in duration (Table 2). Active voluntary MUP recruitment and presence of polyphasic MUPs within the first 6 months after lesion onset predicted recovery [3]. In contrast to other studies, this review stated that pathological spontaneous activity like positive sharp waves and/or fibrillation potentials did not predict outcome. When analyzing the predictive value of pathological spontaneous activity, it has to be taken into account that pathological spontaneous activity, if it occurs, it occurs within 2–3 weeks and often no longer than 2–3 months after onset of the lesion, whereas synkinetic reinnervation activity typically does not occur earlier than 2 months after onset. The predictive value of LEMG therefore depends on the timing of the LEMG [8, 11]. The presence of electrical synkinesis seems to decrease the likelihood of motor recovery, but only few data are available [3]. The result of LEMG often changes the initial diagnosis. LEMG is reliable to detect the most common other differential diagnoses to VFP caused by recurrent nerve neuropathy in patients with vocal fold immobility, i.e. cricoarytenoid fixation and superior laryngeal neuropathy