REHABILITATION OF THE PARALYZED LARYNX

喉麻痹是一种使人衰弱，有时甚至危及生命的疾病。 临床问题本研究的目的是：1）评估 通过测量单侧和双侧瘫痪的治疗效果 患者声音、气道保护和呼吸功能的变化 治疗后，2）开发新的动态方法， 使用功能性电刺激（FES）进行康复， 动物模型中的神经再支配策略。治疗单侧 瘫痪（例如，注射甲状腺素，甲状腺成形术）试图改善声音 通过使声带内侧化来提高音质。双侧瘫痪的治疗 (e.g.激光杓状软骨切除术）的目的是扩大气道， 声带或声门缝隙这些方法都小于 理想的，因为他们改善了一个喉功能的代价， 另它们还代表静态的、不可逆的过程， 萎缩对声带质量和位置的长期影响。功能 电刺激提供了一种更符合生理的治疗方法。在 双侧麻痹1例，环杓后肌麻痹 可以通过吸气信号刺激声带 源自横膈膜、膈神经或胸膜腔内（外展肌 起搏）。在非吸气阶段，声带会被动地 向中线放松，允许不妥协的声音产生， 呼吸道保护在单侧麻痹的情况下，内收肌麻痹或 可刺激外展肌以恢复这两条声带中的任一条 功能协调发展的肌肉的刺激是由 从对侧未瘫痪的伙伴身上的能力 电刺激使瘫痪的喉部恢复活力将被探索 在犬科动物的慢性实验中， 刺激/传感器装置。还将进行研究，以确定是否 电刺激可以对失神经支配的神经系统产生其它有益的效果。 喉肌及其神经再支配的可能过程。慢性 电刺激可以防止或逆转去神经萎缩， 保持或恢复肌肉力量在正常范围内。它可能会使一个 肌肉对外来神经的再支配不敏感， 通过自身的内在神经进行神经再生。最后，电刺激 在存在直流电场的情况下可以吸引再生的神经纤维 以前支配的肌肉，提供了一种选择性的手段， 神经再生在成功制定了FES方法之后， 动物，实验研究将开始在患者中比较， 治疗效果与常规方法。

Laryngeal paralysis is a debilitating and sometimes life-threatening clinical problem. The goals of the proposed research are to: 1) assess the treatment effacies for unilateral and bilateral paralysis by measuring changes in voice, airway protection, and respiratory functions in patients following treatment, and 2) develop new dynamic approaches to rehabilitation using functional electrical stimulation (FES) and reinnervation strategies in animal models. Treatments for unilateral paralysis (e.g. teflon injection, thyroplasty) attempt to improve voice quality by medializing the vocal cord. Treatments for bilateral paralysis (e.g. laser arytenoidectomy) aim to enlarge the airway by lateralizing the vocal cord or creating a glottal chink. These approaches are less than ideal, since they improve upon one laryngeal function at the expense of another. They also represent static, irreversible processes that ignore the long term effects of atrophy on vocal cord mass and position. Functional electrical stimulation offers a more physiologic approach to treatment. In case of bilateral paralysis, the paralyzed posterior cricoarytenoid muscles could be stimulated to abduct the vocal cords using inspiratory signals derived from the diaphragm, phrenic nerve, or intrapleural space (abductor pacing). During noninspiratory phases, the vocal cords would passively relax towards the midline, allowing uncompromised voice production and airway protection. In case of unilateral paralysis, a paralyzed adductor or abductor muscle could be stimulated to restore either of these vocal cord functions. Stimulation of a muscle would be triggered by signals derived from its unparalyzed partner on the contralateral side. The ability of electrical stimulation to reanimate the paralyzed larynx will be explored in chronic experiments on canines, implanted with miniaturized stimulation/sensor devices. Studies will also be performed to determine if electrical stimulation can produce other beneficial effects on a denervated laryngeal muscle and the possible course of its reinnervation. Chronic electrical stimulation may prevent or reverse denervation atrophy, and maintain or restore muscle strength to within normal limits. It may make a muscle refractory to reinnervation by a foreign nerve and encourage reinnervation by its own intrinsic nerve. Finally, electrical stimulation in the presence of a d.c. field may attract regenerating nerve fibers that previously innervated the muscle, providing a means for selective reinnervation. Following successful development of an FES approach in animals, experimental studies will begin in patients to compare the treatment efficacy with conventional methods.