Vascular Connective Tissues as a Factor in onset of Idiopathic Vocal Fold Paralysis

项目总结/摘要：本研究的目标是系统地研究 主动脉弓和肺动脉的顺应性水平对心脏功能受损的影响 迷走神经喉返分支（RLN）与单侧声带麻痹（UVP）相关。 喉返神经为控制喉内声带的肌肉提供感觉运动神经支配。声乐 褶皱功能对于吞咽期间保护气道、调节呼吸以及 声音制作患有UVP的人经常在进食时感到窒息，呼吸困难， 说话困难。大多数被诊断患有UVP的人年龄超过45岁。虽然 手术是UVP最常见的病因，大约12-42%的诊断为UVP的患者没有 已知原因（即特发性）。先前研究马的特发性UVP发作的工作确定了神经变化 以及主动脉弓附近喉返神经慢性受压的特征。我们的团队最近 发现iUVP患者的主动脉弓顺应性显著高于年龄， 性别匹配的对照作为iUVP的可能影响因素。这一发现支持了我们的假设， 主动脉弓动态直径变化引起的喉返神经应力和应变水平可影响喉返神经功能。 肺动脉顺应性水平的相似模式也在同一组中被确定， iUVP与正常对照相比，表明血管顺应性的全身变化。鉴于左翼 RLN最常与iUVP相关，我们假设大规模合规水平的提高- 邻近RLN的直径血管（即主动脉弓和肺动脉）可损害RLN功能 由于过度的压力和应变水平损害了神经的保护层结缔组织 导致神经纤维受损本项目的目标是调查 与猪喉返神经功能受损相关的主动脉。我们还将扩大主动脉弓的成像， 肺动脉包括右锁骨下动脉，以确定是否血管顺应性水平 与对照组相比，iUVP组之间通常存在差异。此外，我们还将比较合规性水平 大直径血管（主动脉弓）和小直径血管（右锁骨下动脉）之间的相关 iUVP受试者和匹配的正常对照之间的RLN。结果将回避 血管大小是否解释了左侧iUVP的优势。系统比较医学、 人类受试者群体之间的环境和遗传历史数据也将有助于识别风险 与脉管系统的超顺应性相关的因素。该项目的成果将阐明 iUVP患者中血管超顺应性对喉返神经功能受损的影响，并确定合并症， 未来可能导致iUVP预防或替代治疗方法的风险因素。

PROJECT SUMMARY / ABSTRACT: The goal of this research is to systematically investigate the contribution of the compliance levels of the aortic arch and pulmonary artery to onset of impaired function of the recurrent laryngeal branch (RLN) of the vagus nerve associated with unilateral vocal fold paralysis (UVP). The RLN provides sensorimotor innervation to the muscles that control the vocal folds within the larynx. Vocal fold function is important for protection of the airway during swallowing, the regulation of breathing, and for voice production. Individuals with UVP frequently experience choking while eating, difficulty breathing, and difficulty speaking. The majority of individuals diagnosed with UVP are older than 45 years of age. Although surgery is the most common etiology of UVP, approximately 12-42% of those diagnosed with UVP have no known cause (i.e. idiopathic). Prior work studying idiopathic onset of UVP in horses identified nerve changes and characteristics indicative of chronic compression on the RLN near the aortic arch. Our team recently identified that individuals with iUVP exhibited significantly higher aortic arch compliance than age- and gender-matched controls as a possible contributing factor in iUVP. This finding supported our hypothesis that RLN stress and strain levels associated with aortic arch dynamic diameter changes could impact RLN function. Similar patterns in pulmonary artery compliance levels were also identified in the same group of those with iUVP compared to normal controls suggesting a systemic change in vascular compliance. Given that the left RLN is most commonly associated with iUVP, we hypothesize that increased compliance levels in large- diameter blood vessels adjacent to the RLN (i.e. aortic arch and pulmonary artery) can impair RLN function due to excessive stress and strain levels that compromise the nerve's protective layers of connective tissues resulting in damaged nerve fibers. The goal of this project is to investigate the level of compliance change in the aorta associated with impaired RLN function in pigs. We will also expand imaging of the aortic arch and pulmonary artery to include the right subclavian artery to determine whether vascular compliance levels generally differ between those with iUVP compared to controls. In addition, we will compare compliance levels between a large-diameter vessel (aortic arch) and a small-diameter vessel (right subclavian artery) associated with the RLN between human subjects with iUVP and matched normal controls. Outcomes will eludicate whether the size of vessel explains the predominance of left-sided iUVP. Systematic comparison of medical, environmental, and genetic historical data between human subject groups will also enable identification of risk factors associated with hypercompliance of the vasculature. Outcomes of this project will elucidate the role of vascular hypercompliance on impaired RLN function in those with iUVP and determine co-morbidities and risk factors that could lead to prevention or alternative treatment approaches for iUVP in the future.