1548 Fig. 1. Laryngeal preparation for the laryngeal chemoreflex in puppy. Thyroid cartilage was retracted and bipolar, concentric needle electrode wa

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1 KISEP Head and Neck Korean J Otolaryngol 1999;42: 강아지의후두화학반사에대한실험적연구 박한규 김광문 홍원표 김영호 김명상 김동영 Experimental Study of Laryngeal Chemoreflex in Puppies Han Q Park, MD, Kwang-Moon Kim, MD, Won Pyo Hong, MD, Young-Ho Kim, MD, Myung Sang Kim, MD and Dong Young Kim, MD Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea ABSTRACT Background and ObjectivesMechanical or chemical stimulation of the supraglottic mucosa may result in either or both of two responses: the laryngeal adductor reflex response LAR, which causes glottic closure, and the laryngeal chemoreflex LCR, which results in centrally mediated apnea, hemodynamic instability and swallowing. Exaggeration of this normally protective reflexes is thought to be responsible for several disorders, including the sudden infant death syndrome SIDS. Material and MethodsThe supraglottic laryngeal mucosa which was topically stimulated by saline, distilled water, cow's milk and acid at ph 1.0 was introduced in 14 anesthetized puppies of three different age groups. In group, four puppies were 2-weeks-of-age, and in group and, five puppies were 4 and 6-weeks-of-age, respectively. Result1 Strong acid ph 1.0 induced the LCR response. 2 After stimulating, respiration was depressed initially, followed by later hyperventilation. We found strong contraction or laryngospasm of thyroarytenoid TA muscle after a short period of latency. 3 Respiration was not, or minimally depressed in group. Moderate depression or apnea was elicited in group and. 4 After stimulating, the heart rate was reduced, but it had no statistical meaning. 5 We found 3 types of TA muscle contraction pattern. Type showed no laryngospasm, but large contraction wave was noted by EMG. Type showed no laryngospasm, but strong contraction was noted initially and followed by some large waves by EMG. Type showed laryngospasm that was visible to the naked eye and by EMG. 6 Peak to peak amplitude differences of TA muscle were significantly increased statistically in all age groups. ConclusionWe suggest that the LCR is an age-dependent response which is absent in very young puppies before 2 weeks and appears after that age. Thus, it has important implications that postnatal neural maturation may influence laryngeal reflex to some extent. Korean J Otolaryngol 1999;42: KEY WORDSLaryngeal chemoreflex Laryngeal adductor reflex response Superior laryngeal nerve Postnatal neural maturation. 1547

2 1548 Fig. 1. Laryngeal preparation for the laryngeal chemoreflex in puppy. Thyroid cartilage was retracted and bipolar, concentric needle electrode was inserted into thyroarytenoid muscle. Korean J Otolaryngol 1999;42:

3 Fig. 2. Polygraph tracing of responses to acid at ph 1.0 in a case of 2 weeks of age. A Respiration tracing, B TA muscle EMG tracing type, C Heart beat tracing. The arrow shows the acid stimulation point. 1549

Fig. 3. Polygraphic tracng of responses to acid at ph 1.0 in a case of 4 week of age. ARespiration tracing, BTA muscle EMG tracing type, C Heart beat tracing.

ARespiration tracing, BTA muscle EMG tracing type, C Heart beat tracing. The arrow shows the acid stimulation point Table 1.

4 Fig. 3. Polygraphic tracng of responses to acid at ph 1.0 in a case of 4 week of age. ARespiration tracing, BTA muscle EMG tracing type, C Heart beat tracing. The arrow shows the acid stimulation point. Fig. 4. Polygraph tracing of responses to acid at ph 1.0 in a case of 6 weeks of age. ARespiration tracing, BTA muscle EMG tracing type, C Heart beat tracing. The arrow shows the acid stimulation point Table 1. Respiration changes immediate after stimulating the laryngeal mucosa with acid Apnea Respiration depression 5sec 2 weeks n weeks n weeks n Table 2. Respiration changes after the respiratory depression after stimulating the laryngeal mucosa with acid Pre times/min Post times/min p value 2 weeks n * weeks n weeks n *Averagestandard deviation 1550 Korean J Otolaryngol 1999;42:

5 Table 3. Heart rate changes after stimulating the laryngeal mucosa with acid Pre beats/min Post beats/min p value 2 weeks n weeks n weeks n Table 4. Types of TA muscle contraction after stimulating the laryngeal mucosa with acid Type Type Type 2 weeks n weeks n weeks n Table 5. Peak to peak amplitude difference of TA muscle after stimulating the laryngeal mucosa with acid Pre mv Post mv p value 2 weeks n * 4 weeks n weeks n *Exist in only 3 cases 1551

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8 REFERENCES 1) Murakami Y, Kirchner JA. Mechanical and physiological properties of reflex laryngeal closure. Ann Otol Rhinol Laryngol ) Sasaki CT. Development of laryngeal function Etiologic significance in the sudden infant death syndrome. Laryngoscope ) Lanier B, Richardson MA, Cummings C. Effect of hypoxia on laryngeal reflex apnea-implications for sudden infant death. Otolaryngol Head Neck Surg ) Lalakea ML, Anonsen CK, Hannley M. Laryngeal brainstem evoked response A developmental study. Laryngoscope ) Biscoe TJ, Sampson SR. Responses of cells in the brainstem of the cat to stimulation of the sinus, glossopharyngeal, aortic and superior laryngeal nerves. J Physiol ) Anonsen CK, Lalakea ML, Hannley M. Laryngeal brainstem evoked response. Ann Otol Rhinol Laryngol ) Kim KM, Kim KR, Yoon JH, Cho JI, Kim CK, Park YJ. Superior laryngeal nerve brain stem evoked response in the cat. Korean J Otolaryngol ) Yamashita T. Larynx-evoked brain stem response on human. Larynx Jpn ) Davies AM, Koenig JS, Thach BT. Upper airway chemoreflex responses to saline and water in preterm infants. J Appl Physiol ) Goding GS, Richardson MA, Trachy RE. Laryngeal chemoreflex: Anatomic and physiologic study by use of the superior laryngeal nerve in the piglet. Otolaryngol Head Neck Surg ) McCulloch TM, Flint PW, Richardson MA, Bishop MJ. Lidocaine effects on the laryngeal chemoreflex and afferent electrical stimulation reflex. Ann Otol Rhinol Laryngol ) Woodson GE, Brauel G. Arterial chemoreceptor influences on the laryngeal chemoreflex. Otolaryngol Head Neck Surg ) Rimell F, Goding GS Jr, Johnson K. Cholinergic agents in the laryngeal chemoreflex model of sudden infant death syndrome. Laryngoscope ) Loughlin CJ, Koufman JA, Averill DB, Cummins MM, Kim YJ, Little JP, et al. Acid-induced laryngospasm in a canine model. Laryngoscope ) Sutton D, Taylor EM, Lindemann RC. Prolonged apnea in infant monkeys resulting from stimulation of the superior laryngeal nerve. Pediatrics ) Wetmore RF. Effects of acid on the larynx of the maturing rabbit and their possible significance to the sudden infant death syndrome. Laryngoscope ) Goding GS Jr. Correlation of laryngeal chemoreflex severity with laryngeal muscle reponse. Laryngoscope ) Bauman NM, Sandler AD, Schmidt C, Maher JW, Smith RJH. Reflex laryngospasm induced by stimulation of distal esophageal afferents. Laryngoscope ) Suzuki M, Kirchner JA. Afferent nerve fibers in the external branch of the superior laryngeal nerve in the cat. Ann Otol Rhinol Laryngol ) Sasaki CT, Suzuki M. Laryngeal reflexes in cat, dog and man. Arch Otolaryngol Korean J Otolaryngol 1999;42:

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012임수진 Received : 2012. 11. 27 Reviewed : 2012. 12. 10 Accepted : 2012. 12. 12 A Clinical Study on Effect of Electro-acupuncture Treatment for Low Back Pain and Radicular Pain in Patients Diagnosed with Lumbar