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Improvement of respiratory compromise through abductor reinnervation and pacing in a patient with bilateral vocal fold impairment
Author(s) -
Broniatowski Michael,
GrundfestBroniatowski Sharon,
Hadley Aaron J.,
Shah Nemath S.,
Barbu Anca M.,
Phillipbar Sue Ann,
Strohl Kingman P.,
Tucker Harvey M.,
Tyler Dustin J.
Publication year - 2010
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.20698
Subject(s) - medicine , synkinesis , reinnervation , anesthesia , superior laryngeal nerve , laryngoscopy , recurrent laryngeal nerve , larynx , paralysis , vocal folds , electromyography , surgery , physical medicine and rehabilitation , intubation , alternative medicine , pathology , thyroid , palsy
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