Technical approach for reanimation of the chronically denervated larynx by means of functional electrical stimulation

Functional electrical stimulation (FES) of the posterior cricoarytenoid (PCA) muscle to produce vocal fold abduction offers an alternative approach to current surgical therapies for bilateral vocal fold paralysis. The purpose of this study was to characterize the application of FES to chronically denervated PCA muscles. Specific goals were to develop a stimulus delivery system for the PCA muscle, determine a practical means of implantation, and identify stimulus parameters effective in activating chronically denervated muscle. Seventeen dogs were implanted with planar electrode arrays 3 months after unilateral recurrent laryngeal nerve resection. A nail-bed electrode array allowed discrete activation of the PCA muscle and gave the greatest abductions, with minimal charge dissipation. Muscle mapping revealed hot-spot regions on the PCA muscle surface, in which stimulation produced maximum abduction. A conservative stimulus paradigm effective in activating chronically denervated muscle was a 1-second pulse train of 2-millisecond-duration pulses, delivered at a tetanizing frequency of 30 Hz and an amplitude of 4 to 14 mA.