Novel method for confirming appropriate nerve integrity monitor (NIM) endotracheal tube positioning

•The EMG endotracheal Nerve Integrity Monitoring (NIM) system is a system to identify and facilitate protection of the recurrent laryngeal nerve. We discuss two methods to test for the appropriate positioning of the NIM endotracheal tube: Tap Test and Train of Four.•The Tap Test was conducted by tapping the trachea over the vocal cords and the Train of Four test was conducted by anesthesia who placed electrical pads over facial muscles which caused a contraction of the vocal cords. Both of these tests were performed on 176 patients in a prospective study.•Of the 176 patients tested, only 74.4% had a positive Tap Test and 96.6% had a positive TOF test, showing that TOF has a statistically significant better sensitivity (p