Skip to main content
SpringerLink
Log in

Reinnervation und Neurostimulation des Kehlkopfs

Reinnervation and neurostimulation of the larynx

  • Leitthema
  • Published:
HNO Aims and scope Submit manuscript

Zusammenfassung

Der dynamischen Rehabilitation von Stimmlippenparesen sollte zukünftig größere Beachtung geschenkt werden. Bei einseitigem Stillstand kann bei Zeichen der Atrophie und weitem Glottisspalt die unselektive Reinnervation mit der Ansa cervicalis eine Alternative zu Augmentation und Thyreoplastik sein. Für die beidseitige Stimmlippenlähmung zeichnen sich in der aktuellen Literatur mit der selektiven Reinnervation und der Neurostimulation (Pacing) neue Behandlungsansätze ab, die eine weitgehende Wiederherstellung der Atemfunktion – bei gleichzeitigem Erhalt der Stimme – erwarten lassen und den Weg zur klinischen Etablierung der Larynxtransplantation bereiten.

Abstract

Dynamic rehabilitation of vocal fold paralysis (VFP) should receive more emphasis in the future. In unilateral immobility with signs of atrophy and wide glottal gap, non-selective reinnervation with ansa cervicalis may become an alternative to augmentation and thyroplasty. For bilateral VFP progress has been made in the concepts of selective reinnervation and neurostimulation (pacing). These new therapies have the potential to restore near normal respiration—without compromising the voice quality—and may contribute to the development of larynx transplantation surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3

Literatur

  1. Bergmann K, Warzel H, Eckhardt HU et al (1984) Respiratory rhythmically regulated electrical stimulation of paralyzed laryngeal muscles. Laryngoscope 94:1376–1380

    Article  PubMed  CAS  Google Scholar 

  2. Cheetham J, Regner A, Jarvis JC et al (2011) Functional electrical stimulation of intrinsic laryngeal muscles under varying loads in exercising horses. PLOS One 6:e24258

    Article  PubMed  CAS  Google Scholar 

  3. Crumley RL (1983) Phrenic nerve graft for bilateral vocal cord paralysis. Laryngoscope 93:425–428

    PubMed  CAS  Google Scholar 

  4. Feraco P, Bazzocchi A, Righi S et al (2009) Involvement of cricoarytenoid joints in rheumatoid arthritis. J Clin Rheumatol 15:264

    Article  PubMed  Google Scholar 

  5. Forster G, Arnold D, Bischoff SJ et al (2012) Laryngeal pacing in minipigs: in vivo test of a new minimal invasive transcricoidal electrode insertion method for functional electrical stimulation of the PCA. Eur Arch Otorhinolaryngol: 2012 Aug 9 [Epub ahead of print]

    Google Scholar 

  6. Goldfarb D, Keane WM, Lowry LD (1994) Laryngeal pacing as a treatment for vocal fold paralysis. J Voice 8:179–185

    Article  PubMed  CAS  Google Scholar 

  7. Grosheva M, Wittekindt C, Pototschnig C et al (2008) Evaluation of peripheral vocal cord paralysis by electromyography. Laryngoscope 118:987–990

    Article  PubMed  Google Scholar 

  8. Kojima H, Omori K, Shoji K et al (1990) Laryngeal pacing in unilateral vocal cord paralysis. An experimental study. Arch Otolaryngol Head Neck Surg 116:74–78

    Article  PubMed  CAS  Google Scholar 

  9. Kwak PE, Friedman AD, Lamarre ED et al (2010) Selective reinnervation of the posterior cricoarytenoid and interarytenoid muscles: an anatomical study. Laryngoscope 120:463–467

    Article  PubMed  Google Scholar 

  10. Marie JP (2010) Nerve reconstruction. In: Remacle M, Eckel EH (Hrsg) Surgery of larynx and trachea. Springer, Heidelberg, S 279–294

  11. Marina MB, Marie JP, Birchall MA (2011) Laryngeal reinnervation for bilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 19:434–438

    Article  PubMed  Google Scholar 

  12. Mueller AH (2011) Laryngeal pacing for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg 19:439–443

    Article  PubMed  Google Scholar 

  13. Nomura K, Kunibe I, Katada A et al (2010) Bilateral motion restored to the paralyzed canine larynx with implantable stimulator. Laryngoscope 120:2399–2409

    Article  PubMed  Google Scholar 

  14. Otto RA, Davis W (1986) Functional electrical stimulation for the treatment of bilateral recurrent laryngeal nerve paralysis. Otolaryngol Head Neck Surg 95:47–51

    PubMed  CAS  Google Scholar 

  15. Pfeiffer J, Laszig R, Maier W (2011) Intraluminal surgical procedures for glottic enlargement in bilateral vocal fold paralysis in adduction. Chirurg 82:116, 118–124

    Article  PubMed  CAS  Google Scholar 

  16. Rosenthal LH, Benninger MS, Deeb RH (2007) Vocal fold immobility: a longitudinal analysis of etiology over 20 years. Laryngoscope 117:1864–1870

    Article  PubMed  Google Scholar 

  17. Sanders I (1991) Electrical stimulation of laryngeal muscle. Otolaryngol Clin North Am 24:1253–1274

    PubMed  CAS  Google Scholar 

  18. Sapundzhiev N, Lichtenberger G, Eckel HE et al (2008) Surgery of adult bilateral vocal fold paralysis in adduction: history and trends. Eur Arch Otorhinolaryngol 265:1501–1514

    Article  PubMed  Google Scholar 

  19. Schuster M, Eysholdt U (2005) Therapy for unilateral vocal fold palsy. Hno 53:756–765

    Article  PubMed  CAS  Google Scholar 

  20. Sittel C, Stennert E, Thumfart WF et al (2001) Prognostic value of laryngeal electromyography in vocal fold paralysis. Arch Otolaryngol Head Neck Surg 127:155–160

    PubMed  CAS  Google Scholar 

  21. Tsunoda K, Kikkawa YS, Kumada M et al (2003) Hoarseness caused by unilateral vocal fold paralysis: how long should one delay phonosurgery? Acta Otolaryngol 123:555–556

    Article  PubMed  Google Scholar 

  22. Tucker HM (1979) Reinnervation of the paralyzed larynx: a review. Head Neck Surg 1:235–242

    Article  PubMed  CAS  Google Scholar 

  23. Volk GF, Hagen R, Pototschnig C et al (2012) Laryngeal electromyography: A proposal for guidelines of the European Laryngological Society. Eur Arch Otorhinolaryngol: 2012 May 11 [Epub ahead of print]

    Google Scholar 

  24. Wang W, Chen D, Chen S et al (2011) Laryngeal reinnervation using ansa cervicalis for thyroid surgery-related unilateral vocal fold paralysis: a long-term outcome analysis of 237 cases. PLOS One 6:e19128

    Article  PubMed  CAS  Google Scholar 

  25. Woodson G (2011) Arytenoid abduction for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg 19:428–433

    Article  PubMed  Google Scholar 

  26. Woodson G (2008) Evolving concepts of laryngeal paralysis. J Laryngol Otol 122:437–441

    Article  PubMed  CAS  Google Scholar 

  27. Young VN, Rosen CA (2011) Arytenoid and posterior vocal fold surgery for bilateral vocal fold immobility. Curr Opin Otolaryngol Head Neck Surg 19:422–427

    Article  PubMed  Google Scholar 

  28. Zealear DL, Billante CR, Courey MS et al (2003) Reanimation of the paralyzed human larynx with an implantable electrical stimulation device. Laryngoscope 113:1149–1156

    Article  PubMed  Google Scholar 

  29. Zealear DL, Dedo HH (1977) Control of paralysed axial muscles by electrical stimulation. Acta Otolaryngol 83:514–527

    Article  PubMed  CAS  Google Scholar 

  30. Zrunek M, Bigenzahn W, Mayr W et al (1991) A laryngeal pacemaker for inspiration-controlled, direct electrical stimulation of the denervated posterior cricoarytenoid muscle in sheep. Eur Arch Otorhinolaryngol 248:445–448

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung(en) hin: Die Klinik der Autoren wird im Rahmen eines Drittmittelprojekts von der Fa. Med-El finanziell unterstützt. Die Autoren erhielten Reisekostenerstattungen durch Med-El zur Teilnahme an Fachkongressen. Die Abb. 3 wurde von Med-El erstellt.

Author information

Authors and Affiliations

  1. Klinik für HNO-Heilkunde/Plastische Operationen am SRH Wald-Klinikum Gera gGmbH, Straße des Friedens 122, 07548, Gera, Deutschland

    A.H. Müller & G. Förster

Authors
  1. A.H. Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Förster
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A.H. Müller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Müller, A., Förster, G. Reinnervation und Neurostimulation des Kehlkopfs. HNO 61, 102–107 (2013). https://doi.org/10.1007/s00106-012-2518-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-012-2518-x

Schlüsselwörter

Keywords

Search

Navigation