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Thread: Wise. Question about vocal cords

  1. #21
    Senior Member BigK's Avatar
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    I had vocal nerve damage when I had my accident. I couldn't talk and was not allowed to have any thin liquids in fear of aspirating because one of the two muscles on each side of the throat that closes when you swallow didn't function properly. An ear, nose and throat specialist injected what I beleive was silicone into the non functioning side so that it would work properly. It isn't permanent and would have been needed again if it hadn't come back on it's own after that like it did, thankfully, for me.

  2. #22
    Quote Originally Posted by BigK View Post
    I had vocal nerve damage when I had my accident. I couldn't talk and was not allowed to have any thin liquids in fear of aspirating because one of the two muscles on each side of the throat that closes when you swallow didn't function properly. An ear, nose and throat specialist injected what I beleive was silicone into the non functioning side so that it would work properly. It isn't permanent and would have been needed again if it hadn't come back on it's own after that like it did, thankfully, for me.
    you are right we have heard of this also but BOTH of anthony's vocal chords are paralyzed so moving one closer to the other is still not going to work for him because the other one will not move towards it. I think they also use botox for this, I could be wrong.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  3. #23
    Quote Originally Posted by waters3 View Post
    The most closest to what I think will help Anthony would be what Dr. Wise was stating about reinnervating. Dr. Wise when you mentioned how Drs. have done this with facial muscles, peripheral nerve tranfers, etc. Does that mean there are Drs. that specialize in this type of surgery. What kind of Dr. would this be? Do you know any, can you ask around the world to see if a surgery has ever been performed to help restore nerves back to the vocal chords, one vocal chord restored might even be helpful. Thank you.
    Cindy and Anthony,

    I have been looking to see if there is any precedent for doctors who have successfully reinnervated the larynx with the IX, X, or XI cranial nerves (Source). The vagus or Xth cranial nerve normally innervates the larynx. Here is what I have found so far.

    1. Drs. Roger Crumley and James Till at the University of California at Irvine have been reinnervating the larynx (Source).

    2. In 2007, Joel H. Blumin, MD (Associate Professor and Chief, Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin) presented a study where they had done laryngeal reconstruction surgery with reinnervation over the past five years (Source). So, clearly, reinnervation of the larynx is being done in other places as well.

    3. Many surgeons use the ansa cervicalis or the recurrent laryngeal nerve, which is a particular branch of the vagus, to re-innervate the larynx. One study that describes the surgical landmarks for identifying and locating that nerve (Source). However, if it is not possible to find a viable distal stump of that nerve, other surgeons have connected the ansa cervicalis to the thyroarytenoid muscle with some improvement in voice (Source). Note that these are often cases of partial voice losses or unilateral vocal cord paralysis.

    4. The NYU Voice Center has an active group of surgeons who specialize in repair of the larynx. They have sober statement concerning reinnervation of the larynx (Source)

    Laryngeal Reinnervation

    The ultimate goal in treating a patient with a vocal cord paralysis is to reinnervate (supply a new, functioning nerve supply to) the paralyzed vocal cord. Much research has gone into this concept, but the goal remains elusive for many reasons. The most important reason is the complexity of the normal nerve supply to the vocal cord. Any attempt at reinnervation, in order to get the vocal cord to function normally, would need to hook up hundreds of microscopic nerves together with at least five tiny muscles in precisely the right combination (and without a map of which nerve goes where).

    The latest research has allowed nerves to be hooked up to individual muscles, but the vocal cord cannot be made to move normally. The purpose of the reinnervation is to prevent further atrophy of the vocal cord muscle. Often, even with this, a laryngoplasty is necessary, as it may take up to a year for the nerve-muscle hookup to occur after the procedure. Many researchers doubt whether the ultimate goal of providing normal vocal cord motion through reinnervation will ever be possible.
    This opinion may be too pessimistic but it is worthwhile to get both sides of any argument. There is much evidence that the vagus system is quite plastic in its ability to adapt to changes. By the way, the vagus innervates the heart, intestines, and many other internal structures of the body. I also found many engineering and basic science studies of laryngeal re-innervation. This is quite an active field of study and there is much going on that may reach clinical practice. In any case, just the sources that I have found above should be able to provide further advice concerning what to do.

    Wise.
    Last edited by Wise Young; 06-19-2009 at 06:48 PM.

  4. #24
    Thanks so much for looking into this, Wise! (and all while traveling to Taiwan, right?) This is useful information for me as well since I may have some nerve trouble after my resection surgery. The scary risk is that I may lose ability to speak or swallow altogether although it is a small risk. There are many people with vocal cord paralysis so you'd be surprised what you find online in terms of support groups.

  5. #25
    Quote Originally Posted by ricanstruction View Post
    Thanks so much for looking into this, Wise! (and all while traveling to Taiwan, right?) This is useful information for me as well since I may have some nerve trouble after my resection surgery. The scary risk is that I may lose ability to speak or swallow altogether although it is a small risk. There are many people with vocal cord paralysis so you'd be surprised what you find online in terms of support groups.
    Rican, you are quite welcome. It is astonishing how much online time I can get while waiting for airplanes and the like. What strikes me about the laryngeal reinnervation is the relative primitiveness of the surgical reconnections that have been tried to date. Let me explain.

    First, use of other nerves to reinnervate the larynx. The XI (eleventh) cranial nerve is the called the spinal accessory nerve. It normally innervates the neck muscles but part of it contributes to the vagus. I know of one doctor in China who actually uses part of the spinal accessory nerve to restore biceps and even triceps function in people with high spinal cord injury. I don't see much activity looking at using the spinal accessory nerve or the IX cranial nerve (which innervates the pharynx) to control the larynx. Part of it may be because the anatomy is so complicated and one may not want to compromise neck movement and swallowing. Alternatively, one can bridge from up higher in the vagus nerve to the larynx.

    Second, use artificial voice boxes that can be controlled by nerve impulses. I have not see this but I would have thought that this would be one of the first areas to be developed. It is relatively easy to record nerve impulses from peripheral nerves. It is likewise easy to translate nerve signals to sound (i.e. one controlling intensity, one controlling pitch, and one interrupt. It is would like playing a string on a guitar (the vocal cord is just a string). With essentially three streams of impulses, one can make a wide range of sounds, just like one can on guitar hero.

    Third, use of EEG (electroencephalographic signals) to control sound. They are using these to control movements of a cursor on the screen. Why not sound?

    These may have been done already and I am just not finding them. I will keep looking.

    Wise.

  6. #26
    Senior Member lunasicc42's Avatar
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    thank you wise. The question of if I will ever speak again is always in the back of my mind. I hope reinnervation/this doctor up in boston can help.

    If you can find anymore information it would be greatly appreciated

    So my general take on this is that it can possibly be done but is very difficult? Or what in sumerization? (sp)
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  7. #27
    Senior Member lunasicc42's Avatar
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    bump...
    "That's not smog! It's SMUG!! " - randy marsh, southpark

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  8. #28
    ricanstruction,

    Thank you for giving us this information. Dr. Zeitels from Mass General called me this morning! We talked abit about Anthony's complex situation, past and present and he told me that he has helped ppl that have had paralysis of both vocal chords. He told me of some procedures that might be able to help anthony. Already forgot what they are, but some hope there. I know his ENT's here and in Miami are probably going to cringe at the thought of Anthony having any more procedures done around the throat area, but we at least have to hear what he has to say.

    Anyway I am having Anthony's ENT's send Dr. Zeitels the most detailed reports and pics up to him and probably will make a trip up there.

    Quote Originally Posted by ricanstruction View Post
    Luna,

    I have tracheal stenosis, which means my trachea is closed off due to scar tissue. air cannot pass through my vocal chords to speak. I have a tracheostomy to breathe and use a device to speak. Can you use any device for speech? I know how frustrating it is. I'm going to Mass General in boston for a resection surgery and possible trachea reconstruction. They are THE BEST in the country. Look them up online. I'm going to see Dr. Mathisen and he gives me hope to speak again. I know your problem is much different but they have voice specialists. Look up online communities with your condition. That helped me out tons too.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  9. #29
    thank you dr. Wise for taking the time out for us to give us these sources of information. I will check them all out.

    I spoke with a Dr. Zeitels up at Mass General this morning and will eventually go up there to see what he has to say (see post right above). He spoke nothing of reinnervating nerves. So the options you gave us are another avenue we can look into also.

    I vaguely(sp?) remember early on a Dr. saying something about Anthony's vagus nerve and it was giving him problems but I can't remember what. When ppl are in the acute stage of sci do they usually have a problem with the vagus nerve? I would hate to mess with it if Anthony's is weak, but that was a long time ago and for the life of me I can't remember what it was making him have problems with.

    Quote Originally Posted by Wise Young View Post
    Cindy and Anthony,

    I have been looking to see if there is any precedent for doctors who have successfully reinnervated the larynx with the IX, X, or XI cranial nerves (Source). The vagus or Xth cranial nerve normally innervates the larynx. Here is what I have found so far.

    1. Drs. Roger Crumley and James Till at the University of California at Irvine have been reinnervating the larynx (Source).

    2. In 2007, Joel H. Blumin, MD (Associate Professor and Chief, Division of Laryngology and Professional Voice, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin) presented a study where they had done laryngeal reconstruction surgery with reinnervation over the past five years (Source). So, clearly, reinnervation of the larynx is being done in other places as well.

    3. Many surgeons use the ansa cervicalis or the recurrent laryngeal nerve, which is a particular branch of the vagus, to re-innervate the larynx. One study that describes the surgical landmarks for identifying and locating that nerve (Source). However, if it is not possible to find a viable distal stump of that nerve, other surgeons have connected the ansa cervicalis to the thyroarytenoid muscle with some improvement in voice (Source). Note that these are often cases of partial voice losses or unilateral vocal cord paralysis.

    4. The NYU Voice Center has an active group of surgeons who specialize in repair of the larynx. They have sober statement concerning reinnervation of the larynx (Source)


    This opinion may be too pessimistic but it is worthwhile to get both sides of any argument. There is much evidence that the vagus system is quite plastic in its ability to adapt to changes. By the way, the vagus innervates the heart, intestines, and many other internal structures of the body. I also found many engineering and basic science studies of laryngeal re-innervation. This is quite an active field of study and there is much going on that may reach clinical practice. In any case, just the sources that I have found above should be able to provide further advice concerning what to do.

    Wise.
    Cindy Waters
    mom to Anthony, right c5, left c4 (24yo)
    injury march 2003

  10. #30
    Quote Originally Posted by waters3 View Post
    thank you dr. Wise for taking the time out for us to give us these sources of information. I will check them all out.

    I spoke with a Dr. Zeitels up at Mass General this morning and will eventually go up there to see what he has to say (see post right above). He spoke nothing of reinnervating nerves. So the options you gave us are another avenue we can look into also.

    I vaguely(sp?) remember early on a Dr. saying something about Anthony's vagus nerve and it was giving him problems but I can't remember what. When ppl are in the acute stage of sci do they usually have a problem with the vagus nerve? I would hate to mess with it if Anthony's is weak, but that was a long time ago and for the life of me I can't remember what it was making him have problems with.
    You are a great mom. Wise.

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