Document Detail


Reanimation of the paralyzed human larynx with an implantable electrical stimulation device.
MedLine Citation:
PMID:  12838013     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES/HYPOTHESIS: Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment. STUDY DESIGN: A prospective study of six patients. METHODS: The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values. RESULTS: The optimum stimulus paradigm was a 1- to 2-second train of 1-millisecond pulses delivered at a frequency of 30 to 40 Hz and amplitude of 2 to 7 V. Posterior cricoarytenoid stimulation produced a large dynamic abduction (3.5-7 mm) in three patients and moderate abduction (3 mm) in a fourth patient. The fifth patient showed a large but delayed response of 4 mm to stimulation with some lateralization of the vocal fold. In the sixth patient, stimulated abduction was noted on device implantation but was lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients subsequently had decannulation. Long-term stimulation of the posterior cricoarytenoid muscle had no appreciable effect on voice quality. CONCLUSIONS: Electrical stimulation of the posterior cricoarytenoid muscle shows potential as an improved therapy for bilateral vocal fold paralysis.
Authors:
David L Zealear; Cheryl R Billante; Mark S Courey; James L Netterville; Randal C Paniello; Ira Sanders; Garrett D Herzon; George S Goding; Wolf Mann; Hasse Ejnell; Alfons M M C Habets; Roy Testerman; Paul Van de Heyning
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  The Laryngoscope     Volume:  113     ISSN:  0023-852X     ISO Abbreviation:  Laryngoscope     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-02     Completed Date:  2003-08-07     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  8607378     Medline TA:  Laryngoscope     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1149-56     Citation Subset:  IM    
Affiliation:
Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical School, Medical Center North S2100, Nashville, TN 37232, USA. david.zealear@vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Electric Stimulation Therapy* / instrumentation
Electromyography
Female
Humans
Inspiratory Capacity
Laryngeal Muscles / innervation,  physiopathology
Male
Middle Aged
Mouth Breathing
Prospective Studies
Prostheses and Implants
Vocal Cord Paralysis / physiopathology,  therapy*
Vocal Cords / physiopathology
Grant Support
ID/Acronym/Agency:
2R01 DC 01149/DC/NIDCD NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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