Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.
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.
Broniatowski
Michael
M
Department of Otolaryngology-Head and Neck Surgery, Case Western Reserve University School of Medicine, Ohio, USA.
Moore
Nina Z
NZ
Grundfest-Broniatowski
Sharon
S
Tucker
Harvey M
HM
Lancaster
Ellen
E
Krival
Kate
K
Hadley
Aaron J
AJ
Tyler
Dustin J
DJ
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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