Evaluation of the Laryngeal Adductor Reflex with a Mechatronic Micro-droplet Laryngoscope

这项拟议的研究涉及内窥镜、机电一体化微滴消散，用于(1)可控地触发喉内收肌反射(LAR，一种反射性声门关闭机制)和(2)基于图像的喉内收肌反射(LAR)的定性和定量测量。尽管LAR在保护下呼吸道方面起着迫在眉睫的作用，但人们对其基本原理知之甚少。一个原因可能是，到目前为止，还没有用于受控反射触发的实用和安全的设备。汉诺威医学院发音和儿科听力学部最近开发了第一个原型，展示了基于液体的反射刺激的好处。由于多因素的原因，实际原型的缺点与受试者组内不可靠的反射刺激(不到50%)有关。该项目旨在展示微滴悬浮度的优化方法将使有效和可靠的反射表征和测绘成为可能。基于这些方法，我们的假设是可以在喉科和神经喉科进行基础性的新研究(例如反射疲劳或空间反射图)。为了克服目前的局限性，有必要进行技术开发，并将产生一种内窥镜、机电一体化微滴分配器，用于基于图像的LAR测量，从而能够精确地将液滴定位在咽内结构上。工作程序包括：1)与解剖约束相关的设计。根据临床数据，将优化进入患者口腔和咽部的部件的尺寸和轮廓。2)流体输运和悬浮性研究。3)可重复性的实验装置和方法以及可用参数的表征。4)通过图像处理(如三角剖分)和目标可视化(增强现实)的计算机辅助模拟LAR。5)最后，新的方法和新的原型将在神经喉科的背景下进行部分和整体的评估(知情同意受试者试验)。该项目的预期成果是在喉内收肌反射领域进行开创性的研究和知识生成。此外，我们期待一种新的方法，这是可行的可靠的临床诊断吞咽困难。这也为在发音学领域的进一步开发以及对中风后受损患者的护理提供了基础。

The proposed research deals with endoscopic, mechatronic microdroplet dispension for (1) controlled triggering of the laryngeal adductor reflex (LAR, a reflexive glottic closure mechanism ) and (2) image-based qualitative and quantitative measurement of the laryngeal adductor reflex (LAR). Even though LAR plays an imminent role in protecting the lower airways, little is known regarding its basic principles. A reason for this might be, that up to date no practical and safe device exists for the controlled reflex triggering. The Department of Phoniatrics and Pediatric Audiology, Hannover Medical School has recently developed a first prototype that demonstrates benefits of fluid-based reflex stimulation. Disadvantages of the actual prototype have been related to non-reliable reflex stimulation within the subject group (less than 50%) due to multifactorial reasons. This project aims to show that optimized methods for microdroplet dispension will enable valid and reliable reflex characterization and mapping. Based on these methods our hypothesis is that fundamental new research in laryngology and neurolaryngology can be conducted (e.g. reflex fatigue or spatial reflex maps). Technical development is necessary to overcome current limitations and will result in an endoscopic, mechatronic microdroplet dispenser for image-based measurement of LAR that allows precise targeting of the droplets on the endolaryngeal structures. The work program includes: 1) Design with regard to anatomical constraints. Based on clinical data, dimensions and contours of components entering the patients oral cavity and pharynx will be optimized. 2) Investigation on fluid transport and dispension. 3) Reproducible experimental setup and methods as well as characterization of usable parameters. 4) Computer-aided stimulation of LAR by image processing (e.g. triangulation) and target visualization (augmented reality). 5) Finally, new methods and a new prototype will be evaluated in parts and holistic in a neurolaryngological context (informed consent subject trials). The expected outcome of this project is groundbreaking research and knowledge generation in the field of the laryngeal adductor reflex. Additionally, we expect a new method that is feasible for a reliable clinical diagnosis of dysphagia. This also provides the basis for further exploitation in the field of phoniatrics as well as the care of impaired patients, i.e. after stroke.