Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment |
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| Authors: | Michael Broniatowski MD Sharon Grundfest‐Broniatowski MD Aaron J. Hadley BE Nemath S. Shah MS Anca M. Barbu MD Sue Ann Phillipbar MS‐CCC‐SLP Kingman P. Strohl MD Harvey M. Tucker MD Dustin J. Tyler PhD |
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| Affiliation: | 1. Department of Otolaryngology–Head and Neck Surgery , Case Western Reserve University School of Medicine, Cleveland, Ohio;2. the Department of General Surgery, Cleveland Clinic Foundation and the Lerner College of Medicine, Case Western Reserve University School of MedicineCleveland, Ohio;3. the Department of Biomedical Engineering, Case Western Reserve University , Cleveland, Ohio;4. MetroHealth Medical Center, Cleveland, Ohio, U.S.A.;5. Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio |
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| Abstract: | Objectives/Hypothesis. To determine whether respiratory compromise from bilateral vocal fold impairment (paralysis) can be objectively alleviated by reinnervation and pacing. Methods. A patient with paramedian vocal folds and synkinesis had a tracheotomy for stridor after bilateral laryngeal nerve injury and Miller Fisher syndrome. One posterior cricoarytenoideus (PCA) received a nerve‐muscle pedicle fitted with a perineural electrode for pacemaker stimulation. The airway was evaluated endoscopically and by spirometry for up to 1 year. Results. Bilateral vocal fold patency during quiet breathing was reversed to active vocal fold adduction during tracheal occlusion. Peak inspiratory flows (PIFs) were significantly higher (P < .001) after reinnervation. PIFs and glottic apertures increased further under stimulation (42 Hz, 1–4 mA, 42–400 μsec). although the differences were not significant. Conclusions. Based on our preliminary data, PCA reinnervation and pacing offer promise for amelioration of respiratory compromise after paradoxical adduction in bilateral vocal fold impairment. Laryngoscope, 2010 |
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| Keywords: | Respiratory compromise vocal fold impairment synkinesis laryngeal reinnervation electronic stimulation |
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