Paced glottic closure for controlling aspiration pneumonia in patients with neurologic deficits of various causes.

Objectives: We undertook to determine whether paced vocal fold adduction can check aspiration in patients with various neurologic conditions. Methods: Five patients with fluoroscopically documented aspiration and repeated pneumonias were enrolled. Two previously reported patients with hemispheric stroke were compared to 3 additional subjects with brain stem-basal ganglia and cerebellar stroke, cerebral palsy, and multiple sclerosi.s. A modified Vocare stimulator was implanted subcutaneousiy and linked to the ipsilateral recurrent laryngeal nerve via perineural electrodes. Vocal fold adduction and glottic closure were effected with pulse trains (42 Hz: 1.2 niA: 188 to 560 |j.s) and recorded with Enhanced Image J. Fluoroscopy results witb and without stimulation were assessed by 2 independent blinded revievk'ers. Pneumonia rates were compared before, during, and after the 6- to 12-month enrollment periods. Results: There was statistically significant vocal fold adduction (p < 0.05) for all patients, further verified witb bolus arrest (p < 0.05 for thin liquids, thick liquids, and puree depending on the speech-language pathologist). Pneumonia was prevented in 4 of the 5 patients during enrollment. In the fifth patient, who had brain stem-basal ganglia and cerebellar stroke, we were unable to completely seal the glottis and open the cricopharyngeus enough to handle his secretions. Conclusions: Vocal fold pacing for aspiration pneumonia from a variety of neurologic insults appears to be appropriate as long as the glottis can be sealed. It is not sufficient when the cricopharyngeus must be independently opened.