REHABILITATION OF THE PARALYZED LARYNX

描述（改编自研究者摘要）当前治疗 对于双侧喉麻痹采用破坏性外科手术 以牺牲发声和气道为代价来改善通气 保护 后部功能性电刺激（FES） 环杓肌（PCA）恢复声带外展，并提供 一个更有活力和生理性的替代治疗方法。 的 本研究的主要目的是：1）恢复外展 在双侧声带麻痹的动物中，使用经皮 或留置刺激装置，2）以确定慢性 电刺激对PCA最终神经支配的影响。 对犬的初步研究表明，FES不仅 恢复喉的灵活性，但防止失神经萎缩， 维持PCA肌纤维的活力和收缩性。 令人惊讶的是，FES已经被观察到影响神经的再支配。 通过选择性地促进内在神经的神经重连的PCA 纤维，同时抑制来自外源的神经支配。 研究 从拟议的研究将跨越四年期间， 慢性FES对神经和肌肉的影响将被充分记录。 这些信息是至关重要的研究喉起搏之前，可以 在植入患者中进行。 特别令人感兴趣的是， 如果延迟干预，可以逆转去神经萎缩。 定时 FES干预及其拯救PCA纤维免于萎缩的能力 和纤维化将根据肌肉生理学的变化进行评估 和生物化学。 慢性功能性食管炎对食管癌程度和质量的影响 喉返神经（RLN）切断后PCA神经再支配的 和/或修复将使用生理学观察来确定， 喉行为、HRP示踪研究和肌肉组织化学。 如果发现FES可以预防或逆转去神经萎缩， 促进适当的神经重新连接， 犬的双侧麻痹将用于研究FES， 治疗方法 将对市售器械进行评价 以适应喉部起搏。 进一步研究， 一种可注射的微刺激器的开发将在一个 动物模型 这项新技术可以提供显著的优势， 急性双侧瘫痪气管切开术

DESCRIPTION (Adapted from the Investigator's Abstract) Current treatments for bilateral laryngeal paralysis employ destructive surgical procedures that improve ventilation at the expense of voice production and airway protection. Functional electrical stimulation (FES) of the posterior cricoarytenoid (PCA) muscle restores vocal fold abduction, and offers a more dynamic and physiologic alternative to present treatment. The primary objective of the proposed research are: 1) to restore abduction in animals with bilateral vocal fold paralysis using a transcutaneous or indwelling stimulation device, 2) to determine the effects of chronic electrical stimulation on the eventual reinnervation of the PCA. Preliminary studies in the canine have suggested that FES not only restores laryngeal mobility, but prevents denervation atrophy while maintaining the viability and contractility of PCA muscle fibers. Surprisingly, FES has been observed to influence reinnervation of the PCA by selectively encouraging neural reconnection of intrinsic nerve fibers, while repressing reinnervation from foreign sources. Studies from the proposed research will span a four year period during which the effects of chronic FES on nerve and muscle will be fully documented. Such information is critical before studies of laryngeal pacing can be pursued in the implanted patient. Of particular interest is whether FES can reverse denervation atrophy if intervention is delayed. The timing of FES intervention and its capacity to rescue PCA fibers from atrophy and fibrosis will be assessed in terms of changes in muscle physiology and biochemistry. The effects of chronic FES on the extent and quality of PCA reinnervation following Recurrent Laryngeal Nerve (RLN) section and/or repair will be determined using physiological observations of laryngeal behaviors, HRP tracing studies, and muscle histochemistry. If FES is found to prevent or reverse denervation atrophy while promoting appropriate neural reconnection, a clinical model for bilateral paralysis in the canine will be used to study FES as a therapeutic approach. Commercially available devices will be evaluated for adaptation to laryngeal pacing. Further research toward the development of an injectable microstimulator will be pursued in an animal model. This new technology may offer significant advantage over emergency tracheotomy in cases acute bilateral paralysis.