gms | German Medical Science

In patients with bilateral vocal chord paralysis (B-RLNP) an electrical pacing of the posterior cricoarytenoid muscle (PCA) could become an option for improving breathing in foreseeable future. Electrophysiologic feasibility tests in volunteers and in animals showed the necessity of a syncinetic reinnervation of at least one PCA for successful laryngeal pacing. Syncinetic reinnervation is proved by laryngeal electromyography (LEMG). We found that only distinct areas in the PCA are responsive to produce an effective glottal widening ("hot spots"). These "hot spots" vary widely.

We use an anterior transluminal, transcricoidal access to the PCA described by Mu (1990) combined with a fiberoptic visualisation of the needle and the vocal chords. This enables us to prove an effective response to electrical stimulation in the presence of syncinetic reinnervation.

Apart from these electrophysiologic preconditions possible candidates for laryngeal pacing should have sufficient respiration at rest, there should be no severe cardiopulmonary disease and sufficient comprehension for the treatment and possible risks. We recommend to offer an extended electrophysiologic diagnostic consisting of LEMG and an electrical test stimulation to all patients who do not fulfil any of the exclusion criteria.