Characterization and Treatment of the Scarred Vocal Fold

描述（由申请人提供）：声带瘢痕是声带手术后嗓音差的最大原因（Hirano，1995; Woo，Casper，Colton和Brewer，1994）。这样的瘢痕形成导致健康组织被纤维组织替代，这可以不可避免地改变声带功能，导致声带粘膜波减少或缺失（Benninger，Alessi，Archer等人，1996年）。当声带体（肌肉）和覆盖层（上皮和固有层的表层）的分离受到损害时，即使是小的瘢痕病灶也会阻碍声带功能。由于目前对瘢痕声带没有持续有效的治疗方法，因此它是最具挑战性的喉部疾病之一（Thibeault和福特，2003），也是表征咽喉瘢痕的竞争性更新的焦点。该项目的长期目标不再仅仅关注声带沟，而是现在包括更普遍的声带疤痕现象的表征和治疗。这一长期目标将通过表征喉瘢痕及其对发声的影响来实现，包括治疗前和治疗后，使用1）对照实验室实验和2）计算机建模实验。实验室实验将在动物组织和切除的喉模型中研究细胞水平的治疗效果。在过去5年完成的实验的基础上，我们将研究生长因子和维生素A在预防和治疗疤痕中的作用，我们将试图更好地描述声带疤痕及其振动后果。我们已经发现有必要将联合收割机建模和系统的实验室研究相结合，以解决组织特征、几何形状和外科手术之间的复杂相互作用，这是创造合适的临床结果所必需的。这个建议是及时的，因为没有一致有效的治疗方式是已知的疤痕，它仍然是一个未解决的问题phonosurgery。虽然我们最初5年的研究已经产生了几个关键假设来指导治疗方案，但目前的建议将使我们能够证实和/或进一步澄清这些假设，以便它们产生更大的影响。

DESCRIPTION (provided by applicant): Vocal fold scarring is the single greatest cause of poor voice after vocal fold surgery (Hirano, 1995; Woo, Casper, Colton and Brewer, 1994). Such scarring results in replacement of healthy tissue by fibrous tissue, which can irrevocably alter vocal fold function, leading to a decreased or absent vocal fold mucosal wave (Benninger, Alessi, Archer et al., 1996). Even small foci of scar can impede vocal fold function when separation of the body (muscle) and cover (epithelium and the superficial layer of the lamina propria) is compromised. Because there is currently no consistently effective treatment for the scarred vocal fold, it is 1 of the most challenging laryngeal disorders to treat (Thibeault and Ford, 2003) and is the focus of this competing renewal on characterizing taryngeal scars. The long-range aim of this project no longer focuses exclusively on sulcus vocalis, but now encompasses the characterization and treatment of the more universal phenomenon of vocal fold scarring. This long-range objective will be accomplished by characterizing laryngeal scarring and its influence on phonation, both pre-and post-treatment, using 1) controlled laboratory experiments, and 2) computer modeling experiments. The laboratory experiments will investigate treatment effects at the cellular level in animal's tissues and excised larynx models. Building on experiments completed over the last 5 years, we will investigate the role of growth factors and vitamin A in preventing and treating scars, and we will attempt to better characterize scars in the vocal fold and their vibratory consequences. We have found it necessary to combine modeling and systematic laboratory investigations to resolve the complex interactions between tissue characteristics, geometry and surgical requisites necessary to create a suitable clinical outcome. This proposal is timely because no consistently effective treatment modality is known for scarring, and it remains 1 of the unsolved problems of phonosurgery. While our initial 5 years of study have yielded several key hypotheses to guide treatment options, the current proposal will enable us to substantiate and/or further clarify these hypotheses so that they will have a greater impact.