About three quarter million patients per year are affected in the United States by stroke-related dysphagia. Approximately half experience aspiration, which can lead to pneumonia and death. Surgical interventions designed to protect the lungs are usually irreversible, destructive to the upper airway and rarely prevent the need for internal tube feeding. The long term objective of this research is to return the missing coordination to the vocal folds and to allow oral feeding without aspiration. Pilot studies using a FDA approved implantable laryngeal stimulator have given encouraging results in two patients. More preliminary data are necessary, however, to support the clinical feasibility of laryngeal pacing after stroke. An additional eight patients with videofluoroscopic evidence of aspiration and who have failed swallowing rehabilitation by the speech-language pathologist for one year or longer will be considered. Each will receive a stimulator implanted on the chest wall, linked to an electrode passed around the ipsilateral recurrent laryngeal nerve. Aspiration will be prevented by voluntary triggering glottic closure from a switch on an external controller of the device. Based on blind review, statistical comparison between the presence and absence of contrast material below the vocal folds with and without stimulation will establish whether sufficient data are available to pursue clinical applications of laryngeal pacing after stroke.
| Broniatowski, Michael; Moore, Nina Z; Grundfest-Broniatowski, Sharon et al. (2010) Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes. Ann Otol Rhinol Laryngol 119:141-9 |
