Neel K. Bhatt, MD

I am interested in better understanding neuromuscular changes in the larynx, especially with aging and neurodegenerative disease. While the clinical manifestations of laryngeal neuropathy are well-described, objective criteria for diagnosis is lacking. For example, vocal fold paresis, atrophy, and laryngeal hypersensitivity are largely subjective diagnoses, and clinicians often disagree about when to give a particular diagnosis.

Laryngeal nerve conduction studies (NCS) could be useful to both objectively detect and measure the severity of the aforementioned neuropathies. NCS directly assess the integrity of motor and sensory axons by direct electrical stimulation of the nerve. NCS are fundamental in the management of other neuropathies including carpal tunnel syndrome, brachial plexus and spinal cord injuries. However, there are specific technical challenges with performing laryngeal NCS.

Consistent stimulation of the nerve is a principal challenge since the recurrent laryngeal nerve travels deep within the neck. We are exploring several stimulating parameters to optimize reproducibility and patient-tolerability. Previous work has been predominately limited to animal studies, but hopefully we can start investigating laryngeal NCS in awake human subjects. Most recently, we have described a transcutaneous needle-electrode approach using ultrasound guidance in a human cadaveric model. Given the ongoing advances in performing awake procedures in laryngology, there may be interest using this technique if it has sufficient diagnostic value.

Ultimately, I hope laryngeal NCS can be a useful clinical tool and a reliable experimental outcome measure. With a more detailed understanding of motor and sensory disturbances in the larynx, it is possible to develop targeted regenerative therapies for patients with voice, cough, and swallowing disorders.