Dynamic Laryngotracheal Closure for Aspiration: A Preliminary Report
| Autor: | Harvey M. Tucker, Paul Scolieri, Sheryl Brodsky, Sharon Grundfest-Broniatowski, Dustin J. Tyler, Fadi Abbass, Michael Broniatowski |
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| Rok vydání: | 2001 |
| Předmět: |
Male
medicine.medical_specialty Population Electric Stimulation Therapy Aspiration pneumonia Pneumonia Aspiration Bolus (medicine) medicine Humans education Stroke Aged Aged 80 and over education.field_of_study Recurrent Laryngeal Nerve Esophageal disease business.industry Equipment Design Middle Aged medicine.disease Dysphagia Electrodes Implanted Surgery Trachea Otorhinolaryngology Female Larynx medicine.symptom Deglutition Disorders Complication business Airway |
| Zdroj: | The Laryngoscope. 111:2032-2040 |
| ISSN: | 0023-852X |
| DOI: | 10.1097/00005537-200111000-00031 |
| Popis: | Objectives/Hypothesis An estimated 500,000 patients per year in the United States. are affected by stroke-related dysphagia. Approximately half experience aspiration, which can lead to pneumonia or death. Aspiration may result from many factors, including delayed transport of the bolus, faulty laryngeal elevation, and poor coordination or inappropriate timing of vocal cord closure. Interventions carried out to protect the lungs are usually irreversible, destructive to the upper airway, and rarely prevent the need for enteral tube feeding. Study Design We present a report of the first implantations of a new device in an FDA-approved study to restore dynamic laryngotracheal separation. Two stroke patients needing tracheostomy were selected based on chronic aspiration verified by clinical and radiologic criteria (modified barium swallow [MBS]). Methods The left recurrent laryngeal nerve was exposed and electrically stimulated to verify vocal fold adduction. Huntington Medical Research Institute Bipolar Helical Electrodes were then implanted around the nerve. The leads were tunneled and linked to a NeuroControl™ Implantable Receiver–Stimulator placed subcutaneously on the chest wall. Activation of the stimulator was performed through an external transmitter linked by induction. Results The device was successfully triggered intra- and postoperatively. Serial flexible fiberoptic endoscopies and MBS demonstrate that aspiration is systematically arrested using low levels of electrical stimulation (42 Hz, 48–100 μsec, 1 mA). Discussion This pioneering work has shown that aspiration can be controlled without airway damage for a wide population of neurologically impaired patients because it appears more physiological than standard therapies. Conclusion Based on the first two patients, paced laryngotracheal separation is clinically effective in controlling aspiration. |
| Databáze: | OpenAIRE |
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