DEVELOPMENT OF A LARYNGEAL PACER

在双侧声带麻痹（BVCP）的临床疾病中， 喉神经被切断声带不能外展 （打开）吸气时。这种危及生命的情况是由 环杓后肌（PCA）的去神经支配， 腱的唯一外展肌。目前，康复方法 涉及使声带或邻近声带变形的外科手术 结构.手术如激光定侧术和杓状软骨切除术 恢复边缘气道，但同时增加了对 吸气和严重的声音衰减。 最近，一些研究者认为，BVCP可以治疗 使用喉部起搏机制，这是一种功能性的 电刺激（FES）系统。虽然FES系统已经 虽然成功应用于其他类型的可兴奋组织，但没有一个被成功应用于其他类型的可兴奋组织。 由于各种技术和 失神经肌肉特有的概念障碍。 我们广泛的初步研究表明， PCA特有的特性使其适合于 FES系统。此外，它也是研究电 刺激失神经肌肉。从提议的大鼠实验和 狗，将开发一种慢性刺激系统， 外展肌功能与失神经PCA的关系预计该系统 将直接适用于BVCP患者，并适用于 其他神经肌肉功能障碍。

In the clinical disorder of bilateral vocal cord paralysis (BVCP), the nerves to the larynx are severed and the vocal cords cannot be abducted (opened) during inspiration. This life threatening condition is caused by denervation of the posterior cricoarytenoid (PCA) muscles, which are the sole abducting muscles of the cords. Presently, rehabilitative approaches involve surgical procedures which deform the vocal cords or adjacent structures. Operations such as laser lateralization and arytenoidectomy restore a marginal airway, but there is both increased susceptibility to aspiration and severe attenuation of the voice. Recently, a number of investigators have suggested that BVCP can be treated using a laryngeal pacing mechanism, which is a type of functional electrical stimulation (FES) system. Although FES systems have been successfully applied to other types of excitable tissue, none has been developed for denervated muscle because of a variety of technical and conceptual barriers unique to denervated muscle. Our extensive preliminary studies suggest that the anatomic and functional peculiarities specific to the PCA make it suitable for application of an FES system. Furthermore, it is an ideal model for study of electrical stimulation of denervated muscle. From the proposed experiments in rats and dogs, a chronic stimulation system will be developed which will restore abductor function to the denervated PCA. It is expected that this system will be directly applicable to patients with BVCP and will be adaptable to other disorders of neuromuscular function.