Determination of the Optimal Conditions for Laryngeal Pacing with the Itrel Ii Implantable Stimulator

Zealear, David L.; Swelstad, Matthew R.; Sant’Anna, Geraldo Druck; Bannister, Roger A.; Billante, Cheryl R.; Rodríguez, Ricardo J.; Garren, Kurt C.; Billante, Mark; Champney, Michael S.

doi:10.1067/mhn.2001.118246

Cited by 22 publications

(31 citation statements)

References 13 publications

(34 reference statements)

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“…The optimum stimulus paradigm for vocal fold abduction was a 1-2 second train of 1 millisecond pulses delivered at a frequency of 30-40 pulses per second (pps) and amplitude of 2-7 volts. 7 One to two seconds of stimulated abduction allowed sufficient air exchange with each breath. Video stillframes of the glottis were used to measure the distance between the vocal folds at rest and during stimulation.…”

Section: Resultsmentioning

confidence: 99%

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

et al. 2003

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Electrical stimulation of the posterior cricoarytenoid (PCA) muscle, when paced with inspiration, offers a physiologic approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment. In an eighteen-month prospective study, six patients were successfully implanted with an Itrel ® II stimulator (Medtronic, Inc). In post-operative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared to pre-operative values. The optimum stimulus paradigm was a 1-2 second train of 1 millisecond pulses delivered at a frequency of 30-40 hertz and amplitude of 2-7 volts. PCA stimulation produced a large dynamic abduction (3.5 to 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 upon device implantation but lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients were subsequently decannulated. Chronic stimulation of the PCA muscle had no appreciable effect on voice quality. Electrical stimulation of the PCA muscle shows potential as an improved therapy for bilateral vocal fold paralysis.

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Section: Resultsmentioning

confidence: 99%

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

et al. 2003

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“…In addition, as is the case for most and perhaps all vertebrates, the anuran raphe is a major source of serotonergic innervation for the central nervous system. Serotonin is known to affect motoneuron excitability in frogs (Cardona and Rudomin, 1983) and increase excitability of laryngeal motor neurons in mammals (Zealear et al, 2001). The rRpd neurons described here are also likely to be serotinergic and could play an important role in modulating vocal rhythms in X. laevis.…”

Section: Role Of the Dorsal Raphementioning

confidence: 99%

Vocal circuitry inXenopus laevis: Telencephalon to laryngeal motor neurons

Brahic

Kelley

2003

J of Comparative Neurology

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Sexually differentiated calling patterns of Xenopus laevis are conveyed to the vocal organ by a dedicated neuromuscular system. Here, we define afferents to vocal motor neurons and determine whether the connectivity of the vocal pathway is sexually differentiated. The use of fluorescent dextran amines and the isolated brain preparation readily permitted identification of anterograde and retrograde connectivity patterns. The whole-mount preparation allowed us to observe projections in their entirety, including cells of origin of a projection (for retrograde projections), terminal fields (for anterograde connections), and fiber tracts. Major findings are the confirmation of a robust and reciprocal connection between cranial nucleus (n.) IX-X and the pretrigeminal nucleus of the dorsal tegmental area of the medulla (DTAM) as well as between DTAM and the ventral striatum (VS). Newly revealed is the extensive connectivity between the rostral subdivision of the dorsal nucleus raphe (rRpd) and candidate vocal nuclei. In contrast to previous results using peroxidase, we did not observe dramatic sex differences in connectivity, although some connections were less robust in female than in male brains. Some retrograde connections previously observed (e.g., anterior preoptic area to DTAM) were not confirmed. Plausible hypotheses are that a set of rhombencephalic neurons located in DTAM, the inferior reticular formation and n.IX-X are responsible for generating patterned vocal activity, that activity is modulated by neurons in rRpd, and that activity in VS (particularly that evoked by conspecific calls), together with effects of steroid hormones at many sites in the vocal circuit, contribute to the initiation of calling.

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“…Identity of RLN reinnervation was confirmed by the presence of vocal fold movement associated with electrical stimulation. The pattern of electrical pulse delivery (biphase, 10 ms pulse duration, 40 pps, 5 s train interval time, 3 s on and 2 s off) was used to study the characteristics of PCA muscle stimulus-response [2]. The amplitudes of the pulses were increased in a stepwise fashion (0.1 V) using the pulse generator (BL-420s, TaiMeng).…”

Section: Pca Muscle Stimulus-response Activationmentioning

confidence: 99%

“…The pulse amplitudes were obtained from thresholds of movement and complete dynamic PCA muscle response. The distance of vocal movement from complete dynamic PCA muscle responses was also measured in each animal [2]. The tissue specimens of muscle were collected using 2 mm diameter cup forceps after the measurement of PCA muscle stimulus-response activation.…”

Section: Pca Muscle Stimulus-response Activationmentioning

confidence: 99%

“…This technique appears to be appropriate for clinical applications, such as ansa cervicalis to the RLN in patients with unilateral paralysis [1]. Because the denervated PCA muscle was still 10-25% as responsive to stimulation as the innervated unilateral PCA muscle, the application of paced muscle electrical stimulation results has been favorable in animals and preliminary clinical trials using an implantable commercial stimulator [2]. Bilateral PCA muscle reinnervation may be more effective than unilateral PCA muscle denervation on vocal fold movement under the pace stimulation.…”

Section: Introductionmentioning

confidence: 99%

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Changes in electrical response function and myosin heavy chain isoforms following denervation and reinnervation of bilateral posterior cricoarytenoid muscles in dogs

Liu

Cheng

et al. 2014

Acta Oto-Laryngologica

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Denervation produced up-regulation of MyHC-1 and MyHC-Neonatal messenger ribonucleic acid (mRNA) expression. Reinnervation caused a decrease of MyHC-2X mRNA expression. The electrical voltage threshold of vocal fold movement and maximum abduction of denervation were greater than that of the reinnervated or control group. The denervated vocal abduction maximum of response to electrical stimulation was less than that in reinnervation or control groups.

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Determination of the Optimal Conditions for Laryngeal Pacing with the Itrel Ii Implantable Stimulator

Abstract: The optimal stimulus paradigm identified in this study (1 msec pulses delivered at 30 to 40 Hz and 2 to 8.5 mA) has been applied to implanted BVFP patients and improved outcome. Information regarding optimal electrode orientation could also be important to future clinical trials.

Cited by 22 publications

References 13 publications

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

Vocal circuitry inXenopus laevis: Telencephalon to laryngeal motor neurons

Changes in electrical response function and myosin heavy chain isoforms following denervation and reinnervation of bilateral posterior cricoarytenoid muscles in dogs

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