The recurrent laryngeal nerve (RLN) of four anesthetized adult Macaca fascicularis monkeys was stimulated by applying current with blunt electrodes placed unilaterally and bilaterally on the intact neck skin along the tracheoesophageal groove. The stimulus consisted of 2.5- to 4.0-mA cathodal pulses, each of 1-ms duration, beginning at a frequency of 10 Hz and increasing by 10-Hz increments to 100 Hz. Unilateral stimulation from 10 to 30 Hz resulted in a graded vocal cord abduction, with the maximal glottic aperture occurring at 30 Hz. Stimulation above 30 Hz produced a graded cord adduction, with nearly complete glottic closure at 100 Hz; bilateral stimulation yielded similar results, with total glottic closure at 100 Hz. Confirmation of the RLN as mediator of this frequency-dependent cord motion was achieved by surgically isolating it and attaining identical results with direct stimulation. No cardiopulmonary alterations were observed in any trial. Transcutaneous electrical stimulation of the RLN seems to be a relatively safe, reliable, and noninvasive method of controlling vocal cord position and thereby the glottic airway in monkeys.

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Laryngeal electrode platform: an indwelling device for mobilizing the vocal cords.

By passing electrical current across the laryngeal mucosa and esophageal wall, the recurrent laryngeal nerve can be stimulated, thereby mobilizing the vocal cords. In designing a device that would utilize this phenomenon, we theorized that stability, targeting, and mucosal contact could be maximized by an indwelling device that would conform precisely to the topography of the posterior larynx. In five dogs, molds of the hypopharynx and proximal esophagus were fashioned in vivo by injection of an alginate compound. From each mold was constructed a vinyl platform blanketed with electrodes. Each platform fit snugly in place, and could activate the nerve consistently in any of the dogs. With as little as 3 mA pulsatile current, use of specific electrodes enabled bilateral abduction, more than doubling the resting glottic aperture. Bilateral adduction was sometimes attainable. Such a platform may have use in visualizing subglottic lesions, diagnosing laryngeal movement disorders, and facilitating intubation and extubation.

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