Bilateral vocal cord paralysis is a life threatening condition due to the inability of the larynx (voice box) to open during inspiration. It can follow as a complication of thyroid surgery, other trauma to the recurrent laryngeal nerve in the neck, base of skull or chest, by motor vehicle or other accidents, compression by lung or thyroid cancer, cancer surgery, tracheal intubation and varieties of neurological insults. The closed position of the vocal cords seen in such cases results in major compromise of the ability to breathe through the natural passages (nose and mouth), so that breathing becomes only possible through a tracheotomy (neck breathing). Unfortunately, this surgery can have many complications, is socially difficult to bear and is expensive due to necessary long term care. Other surgeries that may open the laryngeal airway are destructive, technically difficult and may lead to aspiration (choking). The long term objectives of this research is to make the vocal cords open to resume natural breathing without the inconveniences of neck surgery. Pilot studies done in the dog have shown frank vocal cord opening when a nerve implanted into the cricoarytenoideus (the only muscle able to open the larynx) was electrically stimulated. A FDA-approved implantable pacemaker was recently used to close the vocal cords of patients aspirating after stroke. We propose to use the same device to have patients voluntarily trigger laryngeal opening by flipping the switch of an external controller when they wish to breathe through the natural passages. Comparing vocal fold positions and the ability to breathe before and during stimulation will establish whether sufficient data are available to pursue clinical applications of laryngeal pacing after bilateral vocal cord paralysis. ? ?
| Broniatowski, Michael; Grundfest-Broniatowski, Sharon; Hadley, Aaron J et al. (2010) Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment. Laryngoscope 120:76-83 |
