Vascular Connective Tissues as a Factor in onset of Idiopathic Vocal Fold Paralysis

血管结缔组织是特发性声带麻痹发病的一个因素

• 批准号: 9899978
• 负责人: Julie M Barkmeier-Kraemer
• 金额: $ 50.37万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-13 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9899978
• 关键词: Action Potentials; Adult; Affect; Age; Age-Years; Aging; Anatomy; Animals; Aorta; Bilateral; Biomechanics; Blood Vessels; Breathing; Caliber; Canis familiaris; Catheters; Cause of Death; Characteristics; Chest; Choking; Chronic; Connective Tissue; Control Groups; Data; Deglutition; Diagnosis; Distal; Eating; Electromyography; Equus caballus; Etiology; Exhibits; Family suidae; Functional disorder; Future; Gender; Genetic; Goals; Histologic; Human; Image; Impairment; Individual; Inferior; Laryngeal muscle structure; Larynx; Lead; Left; Length; Location; Magnetic Resonance Imaging; Measurement; Measures; Medical; Modeling; Motor; Muscle; Neck; Nerve; Nerve Fibers; Operative Surgical Procedures; Outcome; Paralysed; Patients; Pattern; Prevention; Production; Property; Public Health; Pulmonary artery structure; Quality of life; Recurrence; Recurrent Laryngeal Nerve; Regulation; Research; Risk Factors; Role; Side; Signal Transduction; Stress; Stretching; Structure of subclavian artery; System; Testing; Tissues; Vagus nerve structure; Voice; Work; X-Ray Computed Tomography; alternative treatment; aortic arch; base; clinical investigation; cohort; comorbidity; experience; functional loss; human subject; in vivo; in vivo evaluation; nerve injury; nerve supply; pressure; vocal control; vocal cord

PROJECT SUMMARY / ABSTRACT: The goal of this research is to systematically investigate the contribution of the compliance levels of the aortic arch and pulmonary artery to onset of impaired function of the recurrent laryngeal branch (RLN) of the vagus nerve associated with unilateral vocal fold paralysis (UVP). The RLN provides sensorimotor innervation to the muscles that control the vocal folds within the larynx. Vocal fold function is important for protection of the airway during swallowing, the regulation of breathing, and for voice production. Individuals with UVP frequently experience choking while eating, difficulty breathing, and difficulty speaking. The majority of individuals diagnosed with UVP are older than 45 years of age. Although surgery is the most common etiology of UVP, approximately 12-42% of those diagnosed with UVP have no known cause (i.e. idiopathic). Prior work studying idiopathic onset of UVP in horses identified nerve changes and characteristics indicative of chronic compression on the RLN near the aortic arch. Our team recently identified that individuals with iUVP exhibited significantly higher aortic arch compliance than age- and gender-matched controls as a possible contributing factor in iUVP. This finding supported our hypothesis that RLN stress and strain levels associated with aortic arch dynamic diameter changes could impact RLN function. Similar patterns in pulmonary artery compliance levels were also identified in the same group of those with iUVP compared to normal controls suggesting a systemic change in vascular compliance. Given that the left RLN is most commonly associated with iUVP, we hypothesize that increased compliance levels in large- diameter blood vessels adjacent to the RLN (i.e. aortic arch and pulmonary artery) can impair RLN function due to excessive stress and strain levels that compromise the nerve's protective layers of connective tissues resulting in damaged nerve fibers. The goal of this project is to investigate the level of compliance change in the aorta associated with impaired RLN function in pigs. We will also expand imaging of the aortic arch and pulmonary artery to include the right subclavian artery to determine whether vascular compliance levels generally differ between those with iUVP compared to controls. In addition, we will compare compliance levels between a large-diameter vessel (aortic arch) and a small-diameter vessel (right subclavian artery) associated with the RLN between human subjects with iUVP and matched normal controls. Outcomes will eludicate whether the size of vessel explains the predominance of left-sided iUVP. Systematic comparison of medical, environmental, and genetic historical data between human subject groups will also enable identification of risk factors associated with hypercompliance of the vasculature. Outcomes of this project will elucidate the role of vascular hypercompliance on impaired RLN function in those with iUVP and determine co-morbidities and risk factors that could lead to prevention or alternative treatment approaches for iUVP in the future.

项目摘要 /摘要：这项研究的目的是系统地研究 主动脉弓和肺动脉的依从性水平的贡献，对功能受损的发作 迷走神经的复发性喉部分支（RLN）与单侧声带瘫痪（UVP）相关。 RLN为控制喉内的声带的肌肉提供了感觉运动神经。人声 折叠功能对于在吞咽，呼吸调节期间保护气道很重要 语音生产。患有UVP的人在进食时经常经历窒息，呼吸困难和 很难说。大多数被诊断出患有UVP的人年龄在45岁以上。虽然 手术是UVP最常见的病因，大约12-42％的被诊断为UVP的人没有 已知原因（即特发性）。在马匹中研究UVP特发性发作的先前工作确定了神经变化 和特征表明在主动脉弓附近的RLN上进行慢性压缩。我们的团队最近 确定IUVP患者的主动脉弓合规性明显高于年龄和年龄 性别匹配的控制是IUVP中可能的促成因素。这一发现支持我们的假设 与主动脉弓动态直径变化相关的RLN应力和应变水平可能会影响RLN功能。 在同一组中，还确定了肺动脉依从性水平的类似模式 与正常对照相比，IUVP表明血管依从性发生全身性变化。鉴于左边 RLN最常见于IUVP，我们假设在很大的合规水平上提高了 直径与RLN相邻的血管（即主动脉弓和肺动脉）可能会损害RLN功能 由于压力过多和应变水平，损害了结缔组织神经的保护层 导致神经纤维受损。该项目的目的是调查合规性变化的水平 与猪中RLN功能受损相关的主动脉。我们还将扩大主动脉弓的成像和 肺动脉包括右锁骨下动脉，以确定是否血管依从性水平 与对照组相比，IUVP的患者通常有所不同。此外，我们将比较合规级别 在大直径容器（主动脉弓）和小直径（右锁骨下动脉）之间 具有IUVP和匹配正常对照的人类受试者之间的RLN。成果将令人难以置信 容器的大小是否解释了左侧IUVP的优势。医学的系统比较， 人类学科群体之间的环境和遗传历史数据也将识别风险 与脉管系统超稳定性相关的因素。该项目的结果将阐明 IUVP患者的RLN功能受损的血管超稳定性并确定合并症和 将来可能导致IUVP预防或替代治疗方法的危险因素。