FNI

Dynamic Vocal Fold Closure for Prevention of Aspiration

Principal Investigator(s): Dustin Tyler, Ph.D., Michael Broniatowski, MD, FACS

Staff/Students: Aaron Hadley, Nemath Syed Shah

Funding Agencies: VA RR&D

Description
The purpose of this research is to explore functional electrical stimulation of the recurrent laryngeal nerve to close the vocal folds and protect the airway.  The work is seeks to determine the most effective way of returning laryngeal function through testing various electrical stimulators and electrodes while measuring the mechanical output of the laryngeal adductor muscles and the muscle recruitment patterns. This project involves will lead to clinical pilot trials to determine the efficacy of this approach.

Clinical Significance
Vocal fold closure is essential to the protection of the airway from aspiration.  Patients who have suffered from a cerebrovascular accident or stroke often have a resulting paralysis of the vocal folds. During swallowing, fluids can mistakenly travel down the larynx instead of the esophagus. This is a result of discoordinated or absent activation of the laryngeal musculature which fails to close the glottic chink. The entry of foreign matter into the lungs often results in pneumonia and a higher rate of fatality. Through the application of neuroprostheses we hope to enable the control of the laryngeal muscles to dynamically control closure of the airway, thereby protecting the lungs and reducing the risk of pneumonia. Typically, the only recourse available to patients with uncontrolled aspiration is complete prohibition of taking any food orally with all nutrition provided by a tube directly into the stomach with devastating consequences on the patient's quality of life. A neuroprosthesis option could enable normal eating and significantly enhance the patient's quality of life while reducing the likelihood of early motality.