Intermittent and continuous intraoperative nerve monitoring (IONM) has become an important asset for endocrine surgeons over the past decades. The ability to determine neurophysiologic integrity of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) on top of identification and meticulous dissection of the nerve in the surgical field has allowed for advances in technology and improved outcomes when it comes to prevention of vocal fold immobility. This chapter aims to compare in review intermittent and continuous nerve monitoring (I-IONM, C-IONM), as well as the current paradigms of their use.