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Targeted Transtracheal Stimulation for Vocal Fold Closure

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Abstract

Paralysis of the structures in the head and neck due to stroke or other neurological disorder often causes dysphagia (difficulty in swallowing). Patients with dysphagia have a significantly higher incidence of aspiration pneumonia and death. The recurrent laryngeal nerve (RLN), which innervates the intrinsic laryngeal muscles that control the vocal folds, travels superiorly in parallel to the trachea in the tracheoesophageal groove. This study tests the hypothesis that functional electrical stimulation (FES) applied via transtracheal electrodes can produce controlled vocal fold adduction. Bipolar electrodes were placed at 15° intervals around the interior mucosal surface of the canine trachea, and current was applied to the tissue while electromyography (EMG) from the intrinsic laryngeal muscles and vocal fold movement visualization via laryngoscopy were recorded. The lowest EMG thresholds were found at an average location of 100° to the left of the ventral midsagittal line and 128° to the right. A rotatable pair of bipolar electrodes spaced 230° apart were able to stimulate bilaterally both RLNs in every subject. Laryngoscopy showed complete glottal closure with transtracheal stimulation in six of the eight subjects, and this closure was maintained under simultaneous FES-induced laryngeal elevation. Transtracheal stimulation is an effective tool for minimally invasive application of FES to induce vocal fold adduction, providing an alternative mechanism to study airway protection.

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Acknowledgments

This work was funded by a Grant from the Coulter Foundation through the Case-Coulter Translational Research Partnership.

Conflict of interest

D. J. Tyler has an equity stake in Bear Software, LLC, which has commercial interest related to subject matter discussed in the article. P. Thompson, I. Kolb, E. C. Hahn, and D. J. Tyler have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Avenue, Room 309 Wickenden Building, Cleveland, OH, USA

    Aaron J. Hadley, Paul Thompson, Ilya Kolb, Elizabeth C. Hahn & Dustin J. Tyler

  2. School of Medicine, Case Western Reserve University, Cleveland, OH, USA

    Elizabeth C. Hahn

  3. Louis Stokes Cleveland Department of Veterans’ Affairs Medical Center, Cleveland, OH, USA

    Dustin J. Tyler

Authors
  1. Aaron J. Hadley
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  2. Paul Thompson
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  3. Ilya Kolb
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  4. Elizabeth C. Hahn
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  5. Dustin J. Tyler
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Corresponding author

Correspondence to Dustin J. Tyler.

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Hadley, A.J., Thompson, P., Kolb, I. et al. Targeted Transtracheal Stimulation for Vocal Fold Closure. Dysphagia 29, 346–354 (2014). https://doi.org/10.1007/s00455-014-9517-x

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  • DOI: https://doi.org/10.1007/s00455-014-9517-x

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