Implantation of a Recurrent Laryngeal Nerve Stimulator for the Treatment of Spastic Dysphonia

1989 ◽  
Vol 98 (2) ◽  
pp. 130-134 ◽  
Author(s):  
Michael Friedman ◽  
Vytenis T. Grybauskas ◽  
Dean M. Toriumi ◽  
Edward L. Applebaum
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Botulinum Toxin Injection ◽  
Laryngeal Nerve ◽  
Nerve Stimulator ◽  
Peripheral Nerve Stimulator ◽  
Cuff Electrode ◽  
Relative Safety ◽  
Muscle Complex ◽  
Long Term Follow Up ◽  
Cardiopulmonary Monitoring

Spastic dysphonia, a rare speech disorder, is characterized by strained phonation with excessively adducted vocal cords. Recurrent laryngeal nerve section, botulinum toxin injection into the vocalis-thyroarytenoid muscle complex, and other techniques have been used to treat this disorder. We have used percutaneous electrical stimulation of the recurrent laryngeal nerve with good results. Previous dog studies demonstrated the relative safety of an implantable recurrent laryngeal nerve stimulator. In this study, we directly stimulated the recurrent laryngeal nerve and vagus nerve in a dog without change in cardiorespiratory status. A Medtronic peripheral nerve stimulator was implanted in a patient with abductor spastic dysphonia. The cuff electrode was positioned around the recurrent laryngeal nerve and stimulation resulted in improvement in her voice. Extensive cardiopulmonary monitoring did not reveal any adverse response to stimulation and there was no discomfort to the patient. On the basis of the good results of this preliminary study, further study with long-term follow-up is under way.

Adductor Spastic Dysphonia: 1 1/2 Years after Recurrent Laryngeal Nerve Resection

1981 ◽  
Vol 90 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Arnold E. Aronson ◽  
Lawrence W. DeSanto
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Physical Effort ◽  
Patients Âgés ◽  
Reduced Volume ◽  
Follow Up Studies ◽  
Long Term Follow Up ◽  
Selection Of

After recurrent laryngeal nerve resection for adductor spastic dysphonia, the voices of 37 patients (ages 39 to 79 years) were assessed 24 hours, 1 month, 6 months, and 1 year after surgery, and those of 33 patients up to 1 1/2 years after surgery. By 24 hours after surgery, 97% of patients had improved and 3% had failed; by 1 month, 97% were still improved while 3% had failed; by 6 months, 92% had maintained improvement while 8% had failed; by 1 year, 68% were still improved but 32% had failed; and by 1 1/2 years, 61% were still improved while 39% had failed. The patients whose voices improved varied from one another in both type and degree of residual dysphonia. The typical postsurgical voice was free of spasm, with some breathiness, hoarseness, and reduced volume being present. The voices of some patients approached normalcy. To most patients, relief from the physical effort to phonate was as important as the improved voice. Continued long-term follow-up studies and careful, collaborative selection of surgical candidates are needed.

Development of an Attachable Endoscopic Nerve Stimulator for Intraoperative Neuromonitoring during Endoscopic or Robotic Thyroidectomy

2017 ◽  
Vol 158 (3) ◽  
pp. 465-468 ◽  
Author(s):  
Eui-Suk Sung ◽  
Jin-Choon Lee ◽  
Seok Hyun Kim ◽  
Sung-Chan Shin ◽  
Da-Woon Jung ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Real Time ◽  
Robotic Thyroidectomy ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Surgical Instruments ◽  
Nerve Stimulator ◽  
Novel Device ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves

We developed a simple attachable endoscopic nerve stimulator that can be connected to monopolar cauterization surgical instruments. This study on porcine models aimed to investigate the feasibility and efficacy of an attachable endoscopic nerve stimulator for intraoperative neuromonitoring (IONM) before application in humans. We evaluated the electromyography (EMG) amplitudes of 8 recurrent laryngeal nerves in 4 pigs with a conventional nerve probe and the attachable endoscopic nerve stimulator. The attachable endoscopic nerve stimulator was feasible and safe in all cases. There was no significant difference in the EMG amplitude of the recurrent laryngeal nerve among instruments ( P = .429). The application of stimulating dissection with an attachable endoscopic nerve stimulator during endoscopic or robotic thyroidectomy with IONM is simple, convenient, and effective. It provides surgeons with real-time feedback of the EMG response during intermittent IONM. We believe that this novel device could be an essential guide and functional navigator for most surgeons, especially for less experienced ones.

Long-Term Follow-up of Recurrent Laryngeal Nerve Avulsion for the Treatment of Spastic Dysphonia

1996 ◽  
Vol 105 (8) ◽  
pp. 592-601 ◽  
Author(s):  
Brian S. Jewett ◽  
R. E. Stone ◽  
Donald T. Weed ◽  
Cheryl Rainey ◽  
Robert H. Ossoff ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stump ◽  
Self Assessment ◽  
Long Term Follow Up ◽  
Histologic Evaluation ◽  
Distal Nerve ◽  
Medialization Laryngoplasty

Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.

scholarly journals Nerve Stimulator-guided Injection of Autologous Stem Cells Near the Equine Left Recurrent Laryngeal Nerve

10.3791/58023 ◽  
2018 ◽  
Author(s):  
Charlotte Sandersen ◽  
Justine Ceusters ◽  
Alexia Fourez ◽  
Irene Tosi ◽  
Helene Graide ◽  
...  
Keyword(s):  
Stem Cells ◽  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stimulator ◽  
Left Recurrent Laryngeal Nerve

Recurrent Laryngeal Nerve Stimulator

2020 ◽  
Vol 53 (1) ◽  
pp. 145-156 ◽  
Author(s):  
Andreas H. Mueller ◽  
Claus Pototschnig
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stimulator

Treatment of Spastic Dysphonia without Nerve Section

1987 ◽  
Vol 96 (5) ◽  
pp. 590-596 ◽  
Author(s):  
Michael Friedman ◽  
Vytenis Grybauskas ◽  
Dean M. Toriumi ◽  
Edward L. Applebaum
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Stimulus Frequency ◽  
Laryngeal Nerve ◽  
Dramatic Improvement ◽  
Nerve Section ◽  
Cuff Electrode ◽  
Minimal Improvement ◽  
Term Basis ◽  
Stimulation System

Spastic dysphonia is a disorder characterized by strained, constricted phonation with excessively adducted vocal cords. Despite initial success with recurrent laryngeal nerve section, the search for other treatment continues. Our clinical study involved inserting a needle electrode percutaneously into the region of the recurrent laryngeal nerve in five patients with spastic dysphonia. Electrical stimulation resulted in dramatic improvement in three patients and minimal improvement in two. Our experimental study was designed to create an animal model for an implantable nerve stimulator to be used on a long-term basis. A Medtronic spinal cord stimulation system was implanted into a dog, and a cuff electrode was positioned around the recurrent laryngeal nerve. Vocal cord position could be altered by varying the stimulus frequency. Long-term stimulation of the recurrent laryngeal nerve was relatively safe and effective. Eventually, we plan to implant nerve stimulators into spastic dysphonia patients who respond well to percutaneous stimulation.

Safety and Tolerability of the Implantable Recurrent Laryngeal Nerve Stimulator

1994 ◽  
Vol 104 (10) ◽  
pp. 1240???1244 ◽  
Author(s):  
Michael Friedman ◽  
J. F. Wernicke ◽  
David D. Caldarelli
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Laryngeal Nerve ◽  
Nerve Stimulator
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