Unilateral and Bilateral Laryngeal Pacing for Bilateral Vocal Fold Paralysis
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NEUROLARYNGOLOGY (AJ MCWHORTER AND L ADKINS, SECTION EDITORS)
Unilateral and Bilateral Laryngeal Pacing for Bilateral Vocal Fold Paralysis Maria E. Powell 1
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David L. Zealear 1
&
Yike Li 1
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C. Gaelyn Garrett 1
&
Kate Von Wahlde 1 & James Netterville 1
# The Author(s) 2020
Abstract Purpose of Review Present the state-of-the-art overview of laryngeal pacing for treatment of bilateral vocal fold paralysis. A minimally invasive unilateral pacing system and a fully implantable bilateral pacing system are currently in clinical trials. The relative advantages and disadvantages of each are discussed. Recent Findings Research in functional electrical stimulation for the reanimation of the posterior cricoarytenoid muscle has successfully translated from animal models to human clinical trials for unilateral pacing and bilateral pacing. Current findings suggest unilateral pacing in humans significantly improves ventilation but only marginally better than cordotomy. Bilateral pacing in canines increases glottal opening greater than 2-fold over unilateral pacing and restores exercise tolerance to normal. Summary Unilateral pacing can be considered a breathing assist device and may not be appropriate for active individuals. Bilateral pacing may be preferable for patients who wish to engage in strenuous exercise. Minimally invasive systems may be ideal for patients who prefer less invasive implantation and are not concerned with cosmesis. Fully implantable pacing systems offer greater electrode redundancy and stability, resulting in a system that is robust against electrode migration or damage. Keywords Bilateral vocal fold paralysis . Laryngeal pacing . Functional electrical stimulation . Recurrent laryngeal nerve . Ventilation . Posterior cricoarytenoid
Maria E. Powell and David L. Zealear are cofirst authors. This article is part of the Topical collection on Neurolaryngology * David L. Zealear [email protected] Maria E. Powell [email protected] Yike Li [email protected] C. Gaelyn Garrett [email protected] Kate Von Wahlde [email protected] James Netterville [email protected] 1
Department of Otolaryngology, Head & Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
Introduction Vocal fold motion impairment (VFMI) describes the phenomenon of partial or complete disruption of vocal fold abduction and/or adduction during the respiration/ phonation cycle. Importantly, VFMI is a symptom of an underlying disease process rather than a specific diagnosis. Characterization of the underlying etiology and pathophysiology is critical for clinical decision making. VFMI may result from mechanical or neurological disruption of the laryngeal mechanism. In particular, vocal fold paralysis is a form of VFMI caused by lesion(s) of the recurrent laryngeal nerve (RLN), resulting in hypomobility (paresis) or immobility (paralysis) of the vocal folds either unilaterally or bilaterally. While both unilateral vocal fold paralysis (UVFP) and bilateral vocal fold paralysis (BVFP) are of me
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