title: Reanimation of the paralyzed human larynx with an implantable electrical stimulation device.
abstract: OBJECTIVE
  Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment.
  
  
  METHODS
  A prospective study of six patients.
  
  
  METHODS
  The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values.
  
  
  RESULTS
  The optimum stimulus paradigm was a 1- to 2-second train of 1-millisecond pulses delivered at a frequency of 30 to 40 Hz and amplitude of 2 to 7 V. Posterior cricoarytenoid stimulation produced a large dynamic abduction (3.5-7 mm) in three patients and moderate abduction (3 mm) in a fourth patient. The fifth patient showed a large but delayed response of 4 mm to stimulation with some lateralization of the vocal fold. In the sixth patient, stimulated abduction was noted on device implantation but was lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients subsequently had decannulation. Long-term stimulation of the posterior cricoarytenoid muscle had no appreciable effect on voice quality.
  
  
  CONCLUSIONS
  Electrical stimulation of the posterior cricoarytenoid muscle shows potential as an improved therapy for bilateral vocal fold paralysis.
authors.affiliation: Department of Otolaryngology-Head & Neck Surgery, Vanderbilt University Medical School, Medical Center North S2100, Nashville, TN 37232, USA. david.zealear@vanderbilt.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Zealear
authors.forename: Cheryl R
authors.initials: CR
authors.lastname: Billante
authors.forename: Mark S
authors.initials: MS
authors.lastname: Courey
authors.forename: James L
authors.initials: JL
authors.lastname: Netterville
authors.forename: Randal C
authors.initials: RC
authors.lastname: Paniello
authors.forename: Ira
authors.initials: I
authors.lastname: Sanders
authors.forename: Garrett D
authors.initials: GD
authors.lastname: Herzon
authors.forename: George S
authors.initials: GS
authors.lastname: Goding
authors.forename: Wolf
authors.initials: W
authors.lastname: Mann
authors.forename: Hasse
authors.initials: H
authors.lastname: Ejnell
authors.forename: Alfons M M C
authors.initials: AM
authors.lastname: Habets
authors.forename: Roy
authors.initials: R
authors.lastname: Testerman
authors.forename: Paul
authors.initials: P
authors.lastname: Van de Heyning
mesh_terms: D000328:Adult; D000368:Aged; D004599:Electric Stimulation Therapy / Q000295:instrumentation; D004576:Electromyography; D005260:Female; D006801:Humans; D007320:Inspiratory Capacity; D007821:Laryngeal Muscles / Q000294:innervation / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009058:Mouth Breathing; D011446:Prospective Studies; D019736:Prostheses and Implants; D014826:Vocal Cord Paralysis / Q000503:physiopathology / Q000628:therapy*; D014827:Vocal Cords / Q000503:physiopathology