Medialization of the ailing vocal fold by means of thyroarytenoid muscle electrostimulation

Introduction Laryngeal framework surgery is the current golden standard for surgical treatment for unilateral vocal fold paralysis (UVFP). Recently electrostimulation of the thyroarytenoid muscle (TA) has been assessed as potential alternative both in animal models (canine) and in clinical setting. The aim of our work is to determine whether the TA or the Recurrent Laryngeal Nerve (RLN) electrical stimulation in UVFP patient could elicit an effective medialization of the ailing VF.

Material and Methods 7 adult UVFP patients were recruited to the study to test the effects of TA electrostimulation during a standard medialization surgery. Stimulation was delivered between 0.1 and 10 mA; at a frequency of 25-40 Hz; and with a pulse width (PW) between 0.1 and 1 ms. The ailing VF response to the stimulation recorded through laryngoscopy was videotaped.

Results 2/7 (28.6 % ) subjects were withdrawn for non-compliance with the selection criteria. The ailing TA was stimulated in 5/7 patients (71.4 % ). No safety issues occurred. Stimulation with an amplitude of 2.5-3 mA; a PW of 1ms; a frequency of 30 Hz elicited a partial medialization of the ailing VF in 3/5 (60 % ) patients.

Conclusions First results showed that TA electrostimulation can induce partial adduction of the ailing VF in anesthetized patients, although insufficient to induce its complete medialization. Whether in awaken patients or by conditioning of the paralyzed muscle via training, a complete medialization can be obtained will be evaluated in the course of this and next studies, also considering different laryngeal muscles as targets.

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MED-EL Elektromedizinische Geräte GmbH

Publication History

Article published online:
13 May 2021