Bilateral motion restored to the paralyzed canine larynx with implantable stimulator

Nomura, Kenichiro; Kunibe, Isamu; Katada, Akihiro; Wright, Charles T.; Huang, Shan; Choksi, Yash A.; Mainthia, Rajshri; Billante, Cheryl R.; Harabuchi, Yasuaki; Zealear, David L.

doi:10.1002/lary.21065

Cited by 34 publications

(32 citation statements)

References 20 publications

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“…The findings in the current study are quite consistent with previous experiments aiming at remobilizing the PCA muscle in bilateral VCP, which generally reported promising performance [1, 27, 28]. Considering the synchronization between glottal opening movement and inspiration, trigger signals that were somehow related with inspiratory movement could be picked up as feedback to the electrical pacing system [1, 16, 29, 30], for example, EMG of the diaphragm, thoracic wall movement, elongation of the trachea, and temperature difference within respiratory cycle.…”

Section: Discussionsupporting

confidence: 92%

Unilateral Laryngeal Pacing System and Its Functional Evaluation

et al. 2017

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Goal. To establish a reliable instrumental system for synchronized reactivation of a unilaterally paralyzed vocal fold and evaluate its functional feasibility. Methods. Unilateral vocal fold paralysis model was induced by destruction of the left recurrent laryngeal nerve (RLN) in anesthetized dogs. With a micro controller-based electronic system, electromyography (EMG) signals from cricothyroid (CT) muscle on the ipsilateral side were recorded and used to trigger pacing of paralyzed vocalis muscles. The dynamic movement of vocal folds was continuously monitored using an endoscope, and the opening and closing of the glottis were quantified with customized imaging processing software. Results. The recorded video images showed that left side vocal fold was obviously paralyzed after destructing the RLN. Using the pacing system with feedback triggering EMG signals from the ipsilateral CT muscle, the paralyzed vocal fold was successfully reactivated, and its movement was shown to be synchronized with the healthy side. Significance. The developed unilateral laryngeal pacing system triggered by EMG from the ipsilateral side CT muscle could be successfully used in unilateral vocal fold paralysis with the advantage of avoiding disturbance to the healthy side muscles.

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Section: Discussionsupporting

confidence: 92%

Unilateral Laryngeal Pacing System and Its Functional Evaluation

et al. 2017

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“…FES has been applied successfully to neuromuscular defects of the larynx in a number of animal trials, although the underlying laryngeal pathology was different (VF paralysis) [27–29]. In addition, the targeted muscle was different (PCAM instead of TAM) and frequently an intervention with acute RLN injury/denervation was made.…”

Section: Discussionmentioning

confidence: 99%

Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve

et al. 2016

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Age related atrophy of the laryngeal muscles -mainly the thyroarytenoid muscle (TAM)- leads to a glottal gap and consequently to a hoarse and dysphonic voice that significantly affects quality of life. The aim of our study was to reverse this atrophy by inducing muscular hypertrophy by unilateral functional electrical stimulation (FES) of the recurrent laryngeal nerve (RLN) in a large animal model using aged sheep (n = 5). Suitable stimulation parameters were determined by fatiguing experiments of the thyroarytenoid muscle in an acute trial. For the chronic trial an electrode was placed around the right RLN and stimulation was delivered once daily for 29 days. We chose a very conservative stimulation pattern, total stimulation time was two minutes per day, or 0.14% of total time. Overall, the mean muscle fiber diameter of the stimulated right TAM was significantly larger than the non-stimulated left TAM (30μm±1.1μm vs. 28μm±1.1 μm, p<0.001). There was no significant shift in fiber type distribution as judged by immunohistochemistry. The changes of fiber diameter could not be observed in the posterior cricoarytenoid muscle (PCAM).FES is a possible new treatment option for reversing the effects of age related laryngeal muscle atrophy.

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“…Research on laryngeal reinnervation has yielded improved muscle tone, less atrophy and vocal fold bowing, but no mobility gains 33 . Another promising line of research is of implantable stimulators, which maintain mobility and voice patterns, but as yet have yielded results only in experimental studies 34 . Because this was a retrospective study, it is difficult to make accurate short/long term quantitative and qualitative analyses.…”

Section: Discussionmentioning

confidence: 99%

Bilateral vocal fold immobility: diagnosis and treatment

Pinto¹,

Godoy²,

Marquis³

et al. 2011

Braz. j. otorhinolaryngol. (Impr.)

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Vocal fold immobility may be due to bilateral neurogenic paralysis, cricoarytenoid joint fixation, laryngeal synechiae, or posterior glottic stenosis. Treatment aims to establish a patent airway and preserve the function of the glottic sphincter and voice quality. Objetives:To analyze the diagnostic and therapeutic approaches in cases of bilateral vocal fold immobility seen at our unit. Materials and Methods:A retrospective study of 35 patient registries at our unit with a diagnosis of bilateral vocal fold immobility; the etiology and treatment results were evaluated.Results: Among the patients, 18 (51.4%) were cases of bilateral vocal fold palsy, and 17 (48,6%) were cases of posterior glottic stenosis. Patients with bilateral palsy underwent unilateral subtotal arytenoidectomy, and patients with stenosis were treated with the microtrapdoor flap technique, subtotal arytenoidectomy, and/or posterior cricoidotomy (Rethi). Conclusion:Bilateral vocal fold immobility is a potentially fatal condition; it is essential to differentiate vocal fold palsy from fixation to choose the appropriate treatment. Subtotal arytenoidectomy with microscopy is our surgery of choice for treating bilateral paralysis; the technique for treating stenosis depends on the amount of stenosis. Braz J Otorhinolaryngol. 2011;77(5):594-9. ORIGINAL ARTICLE BJORL

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Bilateral motion restored to the paralyzed canine larynx with implantable stimulator

Abstract: This study demonstrates that ventilatory compromise only occurs following faulty reinnervation. Bilateral PCA stimulation can restore ventilation and exercise tolerance completely without aspiration over the long term.

Cited by 34 publications

References 20 publications

Unilateral Laryngeal Pacing System and Its Functional Evaluation

Unilateral Laryngeal Pacing System and Its Functional Evaluation

Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve

Bilateral vocal fold immobility: diagnosis and treatment

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