Zealear D L, Swelstad M R, Sant'Anna G D, Bannister R A, Billante C R, Rodriguez R J, Garren K C, Billante M J, Champney M S
Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University, Nashville, Tennnessee 37232, USA.
Otolaryngol Head Neck Surg. 2001 Sep;125(3):183-92. doi: 10.1067/mhn.2001.118246.
To determine the optimal stimulus paradigm, electrode orientation, and configuration of an implantable stimulator used to reanimate the posterior-cricoarytenoid (PCA) muscle in case of bilateral vocal fold paralysis (BVFP).
Acute studies were conducted on 13 canines implanted with Itrel II systems with or without PCA innervation. PCA stimulus-response characteristics were obtained by measuring stimulated vocal fold displacement endoscopically.
The denervated PCA was only 10% to 25% as responsive to stimulation as the innervated PCA. However, the response could be increased to 38% and 61% if the Itrel was modified to deliver 1 and 2 msec pulses, respectively. Stimuli delivered centrally to the muscle 5 mm from the median raphe improved performance.
The optimal stimulus paradigm identified in this study (1 msec pulses delivered at 30 to 40 Hz and 2 to 8.5 mA) has been applied to implanted BVFP patients and improved outcome. Information regarding optimal electrode orientation could also be important to future clinical trials.
确定用于双侧声带麻痹（BVFP）时使环杓后肌（PCA）恢复活力的植入式刺激器的最佳刺激模式、电极方向和配置。
对13只植入了有或没有PCA神经支配的Itrel II系统的犬进行了急性研究。通过内镜测量受刺激的声带位移来获得PCA刺激-反应特性。
去神经支配的PCA对刺激的反应仅为有神经支配的PCA的10%至25%。然而，如果将Itrel修改为分别发送1毫秒和2毫秒的脉冲，反应可分别提高到38%和61%。从中线距中央5毫米处向肌肉发送刺激可改善效果。
本研究确定的最佳刺激模式（以30至40赫兹和2至8.5毫安发送1毫秒脉冲）已应用于植入式BVFP患者并改善了结果。关于最佳电极方向的信息对未来的临床试验也可能很重要。
