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声音不佳的最大单一原因（Hirano, 1995; Woo, Casper, Colton and Brewer, 1994）。这种瘢痕形成导致健康组织被纤维组织取代，从而不可逆转地改变声带功能，导致声带粘膜波减少或消失（Benninger, Alessi， Archer等，1996）。当机体（肌肉）和覆盖层（上皮和固有层浅层）的分离受损时，即使是小的瘢痕灶也会阻碍声带功能。由于目前对瘢痕声带没有一致有效的治疗方法，它是最具挑战性的喉疾病之一（Thibeault和Ford， 2003），也是喉瘢痕特征的竞争更新的重点。这个项目的长期目标不再仅仅集中在声沟，但现在包括表征和治疗声带瘢痕的更普遍的现象。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)控制实验室实验和2)计算机建模实验。实验室实验将在动物组织和切除喉模型的细胞水平上研究治疗效果。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，我们将尝试更好地表征声带疤痕及其振动后果。我们发现有必要将建模和系统的实验室研究结合起来，以解决组织特征、几何形状和手术要求之间复杂的相互作用，从而创造合适的临床结果。这一建议是及时的，因为对于瘢痕形成没有一致有效的治疗方式，并且它仍然是声外科未解决的问题之一。虽然我们最初5年的研究已经产生了几个指导治疗方案的关键假设，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.