Selective intraoperative stimulation of the human larynx

Authors

  • Michael Broniatowski MD, FACS,

    Corresponding author
    1. Saint Vincent Charity Medical Center, MetroHealth Medical Center, and the Department of Otolaryngology–Head and Neck Surgery , Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
    • 2351 East 22nd Street, Cleveland, OH 44115
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  • Sharon Grundfest-Broniatowski MD, FACS,

    1. Cleveland Clinic Foundation and the CCF Lerner College of Medicine at Case Western Reserve University School of Medicine , Cleveland, Ohio, U.S.A.
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  • Elizabeth C. Hahn,

    1. Department of Biomedical Engineering and Case Western Reserve University School of Medicine , Case Western Reserve University, Cleveland, Ohio, U.S.A.
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  • Aaron J. Hadley,

    1. Department of Biomedical Engineering and Case Western Reserve University School of Medicine , Case Western Reserve University, Cleveland, Ohio, U.S.A.
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  • Dustin J. Tyler PhD,

    1. Department of Biomedical Engineering and Case Western Reserve University School of Medicine , Case Western Reserve University, Cleveland, Ohio, U.S.A.
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  • Harvey M. Tucker MD, FACS

    1. Saint Vincent Charity Medical Center, MetroHealth Medical Center, and the Department of Otolaryngology–Head and Neck Surgery , Case Western Reserve University School of Medicine, Cleveland, Ohio, U.S.A.
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  • Presented at the 2012 American Laryngological Association Meeting, San Diego, California, U.S.A., April 19, 2012.

  • This work was funded by St. Vincent Charity Medical Center and Department of Biomedical Engineering, Case Western Reserve University. The authors have no other funding, financial relationships, or conflicts of interest to disclose.

Abstract

Objectives/Hypothesis:

Laryngeal contraction normally entails activation of mutually cooperative intrinsic laryngeal muscles (ILMs). Unfortunately, standard stimulating methods do not completely mimic the normal ongoing synchrony between the muscles. We submit that this problem can be addressed by modifying the stimulating waveform.

Study Design:

This study extends prior canine research to the human using quasitrapezoidal (QT) currents instead of standard square waves, which while valuable incompletely express normal ILM interactions.

Methods:

In two patients undergoing laryngectomy for cancer, the recurrent laryngeal nerve on the uninvolved side received QT pulses (4 Hz, 60–2,000 μA, 100–500 μs width, 0–500-μs decay) via a bipolar cuff electrode. Pairs of needle electrodes placed into the posterior cricoarytenoideus (PCA), lateral cricoarytenoideus (LCA), and thyroarytenoideus (TA) were used to record electromyography amplitudes, and waveforms were analyzed by a specially designed computer program.

Results:

With activity from square waves serving as control, we observed statistically significant (P < .05) shifts in mutual relationships among PCA, LCA, and TA for an array of specific QT configurations.

Conclusions:

Our preliminary data on selective ILM manipulation offer promise for improved dynamic control of faulty laryngeal contraction patterns.

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