title: Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.
abstract: OBJECTIVE
  We undertook to determine whether paced vocal fold adduction can check aspiration in patients with various neurologic conditions.
  
  
  METHODS
  Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke were compared to 3 additional subjects with brain stem-basal ganglia and cerebellar stroke, cerebral palsy, and multiple sclerosis. A modified Vocare stimulator was implanted subcutaneously and linked to the ipsilateral recurrent laryngeal nerve via perineural electrodes. Vocal fold adduction and glottic closure were effected with pulse trains (42 Hz; 1.2 mA; 188 to 560 micros) and recorded with Enhanced Image J. Fluoroscopy results with and without stimulation were assessed by 2 independent blinded reviewers. Pneumonia rates were compared before, during, and after the 6- to 12-month enrollment periods.
  
  
  RESULTS
  There was statistically significant vocal fold adduction (p < 0.05) for all patients, further verified with bolus arrest (p < 0.05 for thin liquids, thick liquids, and puree depending on the speech-language pathologist). Pneumonia was prevented in 4 of the 5 patients during enrollment. In the fifth patient, who had brain stem-basal ganglia and cerebellar stroke, we were unable to completely seal the glottis and open the cricopharyngeus enough to handle his secretions.
  
  
  CONCLUSIONS
  Vocal fold pacing for aspiration pneumonia from a variety of neurologic insults appears to be appropriate as long as the glottis can be sealed. It is not sufficient when the cricopharyngeus must be independently opened.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Ohio, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Broniatowski
authors.forename: Nina Z
authors.initials: NZ
authors.lastname: Moore
authors.forename: Sharon
authors.initials: S
authors.lastname: Grundfest-Broniatowski
authors.forename: Harvey M
authors.initials: HM
authors.lastname: Tucker
authors.forename: Ellen
authors.initials: E
authors.lastname: Lancaster
authors.forename: Kate
authors.initials: K
authors.lastname: Krival
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Hadley
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Tyler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002547:Cerebral Palsy / Q000150:complications*; D004599:Electric Stimulation Therapy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005931:Glottis / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications*; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D020521:Stroke / Q000150:complications*; D016896:Treatment Outcome; D014827:Vocal Cords / Q000503:physiopathology
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