Sinclair CF, et al. - A novel method of continuous intraoperative neuromonitoring is laryngeal adductor reflex–continuous intraoperative neuromonitoring (LAR-CIONM), which elicits a laryngeal reflex response (LAR). LAR-CIONM was undertaken in 300 nerves at risk, two patients have had postoperative permanent vocal fold immobility (VFI). Prior to the complete loss of signal, a significant LAR amplitude increase was observed in both patients. LAR hyperexcitability was not evident in any of the patients. If verified in a larger sample, this work represents the first suggesting the possible value of a vagal intraoperative neuromonitoring technique in distinguishing transient from permanent VFI, which could improve patient outcomes.