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| |  AAO-HNSF: Electrode Diameter May Affect Hoarseness in Vagal Nerve Stimulator Implantation By Paula Moyer Special to DG News SAN DIEGO, CA --September 27, 2002 -- Use of an electrode with the appropriate diameter may reduce the incidence of hoarseness in patients who receive vagal nerve stimulator (VNS) implants for seizure prophylaxis, suggest the results of a study. The diameter of the vagal nerve should be actually measured, not just estimated by visual assessment, said Dr. Perry M. Santos, a head and neck surgeon affiliated with the Otologic Medical Clinic in Oklahoma City, Oklahoma, United States."If the surgeon doing the implantation has the two sizes of electrodes in the operating room, 2 mm and 3 mm, then the one most appropriate for the patient can be selected at the time of implantation." He presented the findings of a prospective study here at the 106th annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation. Dr. Santos and his co-investigators sought to determine the effect that electrode size might have on the vagal nerve and on true vocal cord immobility. In two previous cases of vocal fold immobility associated with a VNS, nerve compression was suspected, he said. Therefore, they wanted to know the effect that intraoperative measurements of the vagal nerve diameter, and subsequent placement of an appropriate-sized electrode, might have on decreasing the risk of vocal fold immobility. Eighteen patients who had been referred from neurologists for VNS implantation were followed. Dr. Santos and colleagues evaluated the patients preoperatively and postoperatively for hoarseness and true vocal cord paresis or paralysis with either a mirror or a laryngovideostroboscopy. They based the electrode size selection on intraoperative vagal nerve measurements. Among the patients, seven had vagal nerves that were less than 2 mm in diameter; therefore, they received the 2-mm inner diameter electrode. Because the remaining 11 patients had vagal nerves that exceeded 2 mm in diameter, they received the 3-mm inner diameter electrode. “No patients experienced either transient or permanent hoarseness, and none had either paresis or paralysis," Dr. Santos said."On the basis of our findings, I never do a VNS implant without having electrodes of both sizes in the operating room."
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