In the clinical disorder of bilateral vocal cord paralysis (BVCP), the nerves to the larynx are severed and the vocal cords cannot be abducted (opened) during inspiration. This life threatening condition is caused by denervation of the posterior cricoarytenoid (PCA) muscles, which are the sole abducting muscles of the cords. Presently, rehabilitative approaches involve surgical procedures which deform the vocal cords or adjacent structures. Operations such as laser lateralization and arytenoidectomy restore a marginal airway, but there is both increased susceptibility to aspiration and severe attenuation of the voice. Recently, a number of investigators have suggested that BVCP can be treated using a laryngeal pacing mechanism, which is a type of functional electrical stimulation (FES) system. Although FES systems have been successfully applied to other types of excitable tissue, none has been developed for denervated muscle because of a variety of technical and conceptual barriers unique to denervated muscle. Our extensive preliminary studies suggest that the anatomic and functional peculiarities specific to the PCA make it suitable for application of an FES system. Furthermore, it is an ideal model for study of electrical stimulation of denervated muscle. From the proposed experiments in rats and dogs, a chronic stimulation system will be developed which will restore abductor function to the denervated PCA. It is expected that this system will be directly applicable to patients with BVCP and will be adaptable to other disorders of neuromuscular function.
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