Apparatus and method to objectively measure sensory discrimination thresholds in the upper aero digestive tract

• US 6,036,655 A
• Filed: 12/07/1995
• Issued: 03/14/2000
• Est. Priority Date: 04/16/1993
• Status: Expired due to Term

• Current Assignee: Trustees Of Columbia University In The City Of New York (Columbia University)
• Original Assignee: Trustees Of Columbia University In The City Of New York (Columbia University)
• Inventors: Martin, John H., Aviv, Jonathan E.
• Primary Examiner(s): HINDENBURG, MAX F
• Application Number:
  US08/532,648
• Time in Patent Office: 1,559 Days
• Field of Search: 600/555, 600/556, 600/560, 600/587, 600/593, 604/23, 604/36
• US Class Current: 600/560
• CPC Class Codes: A61B 1/233 for the nose, i.e. nasoscopes , e.g. testing of patency of Eustachian tubes
• CPC Class Codes: A61B 1/267 for the respiratory tract, e.g. laryngoscopes, bronchoscopes
• CPC Class Codes: A61B 1/2676 Bronchoscopes
• CPC Class Codes: A61B 5/0053 by applying pressure, e.g. compression, indentation, palpation, grasping, gauging
• CPC Class Codes: A61B 5/03 Detecting, measuring or recording fluid pressure within the body other than blood pressure, e.g. cerebral pressure; Measuring pressure in body tissues or organs A61B5/205 takes precedence
• CPC Class Codes: A61B 5/036 by means introduced into body tracts A61B5/032 and A61B5/035 take precedence
• CPC Class Codes: A61B 5/085 Measuring impedance of respiratory organs or lung elasticity
• CPC Class Codes: A61B 5/4233 oesophagus
• CPC Class Codes: A61B 5/4827 assessing touch sensitivity, e.g. for evaluation of pain threshold
• CPC Class Codes: A61M 13/003 Blowing gases other than for carrying powders, e.g. for inflating, dilating or rinsing
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/021 operated by electrical means A61M16/202 – A61M16/205 take precedence
• CPC Class Codes: A61M 16/0858 Pressure sampling ports
• CPC Class Codes: A61M 2230/60 Muscle strain, i.e. measured on the user

Abstract

An apparatus and method to objectively measure sensory discrimination thresholds at a test site in the upper aero digestive tract of a patient. A time and pressure controlled puff of air is delivered to the input of a Y-shaped tube; one output branch of the Y-shaped tube delivers the puff of air to the patient and the other output branch delivers the puff of air to a pressure transducer, for measurement and display of the pressure.

Claims

1. An apparatus for testing sensation in a patient at a test site in the upper aero digestive tract, comprising:

means for generating a time and pressure controlled puff of air;

means, connected to said means for generating, for delivering the controlled puff of air to the test site;

the means for generating a time and pressure controlled puff of air further comprising a source of high pressure air, a pressure regulator receiving the high pressure air, a valve receiving regulated air from the pressure regulator, and means for controllably driving the valve to open and closed positions;

the means for controllably driving the valve to open and closed positions further comprising a trigger circuit producing trigger signals, a valve driver producing drive signals responsive to the trigger signals input from the trigger circuit, and an electrically controlled valve, the open or closed state of which is responsive to drive signals input from the valve driver;

wherein the trigger circuit produces variable duration trigger signals; and

means responsive to the trigger signals of the trigger circuit for outputting stimulus output signals.

2. An apparatus for testing pharyngeal and supraglottic sensation in a patient at a test site in the pharynx or larynx region, comprising:

means for generating a time and pressure controlled puff of air;

means, connected to said means for generating, for delivering the controlled puff of air to the pharynx or larynx region;

the means for generating a time and pressure controlled puff of air further comprising a source of high pressure air, a pressure regulator receiving the high pressure air, a valve receiving regulated air from the pressure regulator, and means for controllably driving the valve to open and closed positions;

the means for controllably driving the valve to open and closed positions further comprising a trigger circuit producing trigger signals, a valve driver producing drive signals responsive to the trigger signals input from the trigger circuit, and an electrically controlled valve, the open or closed state of which is responsive to drive signals input from the valve driver;

wherein the trigger circuit produces variable duration trigger signals; and

means responsive to the trigger signals of the trigger circuit for outputting stimulus output signals.

3. An apparatus for testing sensation in a patient at a test site in the upper aero digestive tract, comprising:

a Y-shaped tube with an inlet branch having an inlet end and first and second outlet branches having respective first and second outlet ends;

the first outlet branch of the Y-shaped tube being inserted into one of the patient'"'"'s nasal passage and oral passage, the first outlet end terminating adjacent the test site;

a pressure transducer connected to the second outlet branch of the Y-shaped tube, axially aligned with the second outlet end;

means for delivering a time and pressure controlled puff of air detachably connected to the inlet end of the Y-shaped tube;

display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer;

the first and second outlet branches being substantially the same length;

the means for delivering a time and pressure controlled puff of air to the inlet end of the Y-shaped tube further comprising a source of high pressure air, a pressure regulator receiving the high pressure air, a valve, connected between the pressure regulator and the inlet end of the Y-shaped tube, receiving regulated air from the pressure regulator;

means for controllably driving the valve to open and closed positions;

the means for controllably driving the valve to open and closed positions further comprising a trigger circuit producing trigger signals, a valve driver producing drive signals responsive to the trigger signals input from the trigger circuit, and an electrically controlled valve, the open or closed state of which is responsive to drive signals input from the valve driver;

wherein the trigger circuit produces variable duration trigger signals, the display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer comprises a transducer circuit responsive to input from the pressure transducer and a display responsive to input from the transducer circuit, the display is a Light Emitting Diode display;

wherein the pressure transducer is connected to the second outlet branch of the Y-shaped tube about 2 mm from the second outlet end and wherein the test site is about 2 mm from the anterior wall of the patient'"'"'s pyriform sinus; and

means responsive to the trigger signals of the trigger circuit for outputting stimulus output signals.

4. An apparatus for testing sensation in a patient at a test site in the upper aero digestive tract, comprising:

a Y-connector with an inlet end and first and second outlet ends;

a pressure transducer;

means for delivering a time and pressure controlled puff of air to the inlet end of the Y-connector;

a delivery tube with an inlet end and an outlet end, the delivery tube inlet end being connected to the first outlet end of the Y-connector and the delivery tube outlet end being inserted into the patient'"'"'s nasal passage and terminating adjacent the test site;

a sensor tube with an inlet end and an outlet end, the sensor tube inlet end being connected to the second outlet end of the Y-connector and the sensor tube outlet end being connected to the pressure transducer;

display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer; and

means responsive to trigger signals of a trigger circuit driving the means for producing a time and pressure controlled puff of air for outputting stimulus output signals when the trigger circuit drives the means for producing a time and pressure controlled puff of air;

wherein the delivery tube and the sensor tube are substantially the same length.

5. An apparatus for testing sensation in a patient at a test site in the upper aero digestive tract, comprising:

a flexible fiberoptic telescope inserted at its distal end into one of the patient'"'"'s nasal passage and oral passage, the distal end terminating adjacent the test site;

a Y-connector with an inlet end and first and second outlet ends;

a delivery tube with an inlet end and an outlet end, the delivery tube being detachably attached to the fiberoptic telescope with the outlet end of the delivery tube adjacent the distal end of the fiberoptic telescope and the inlet end of the delivery tube extending outside the patient and being detachably attached to the first outlet end of the Y-connector;

a pressure transducer;

a sensor tube with an inlet end and an outlet end, the sensor tube inlet end being connected to the second outlet end of the Y-connector and the sensor tube outlet end being connected to the pressure transducer;

means for delivering a time and pressure controlled puff of air to the inlet end of the Y-connector;

display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer; and

means responsive to trigger signals of a trigger circuit driving the means for producing a time and pressure controlled puff of air for outputting stimulus output signals when the trigger circuit drives the means for producing a time and pressure controlled puff of air;

wherein the delivery tube and the sensor tube are substantially the same length.

6. A method for testing sensation in a patient at a test site in the upper aero digestive tract, comprising:

generating a time and pressure controlled puff of air;

delivering the controlled puff of air to the test site; and

outputting a stimulus output signal when the controlled puff of air is delivered.

7. A method for testing pharyngeal and supraglottic sensation in a patient at a test site in the pharynx or larynx region, comprising:

generating a time and pressure controlled puff of air;

delivering the controlled puff of air to the pharynx or larynx region; and

outputting a stimulus output signal when the controlled puff of air is delivered.

8. A method for testing pharyngeal and supraglottic sensation in a patient at a test site in the pharynx or larynx region, comprising:

generating six blocks of time and pressure controlled puffs of air, each block including ten puffs of air, each succeeding puff of air in a block differing by a pressure of about 7.5×

10^-2 mm Hg as compared to the preceding puff of air;

delivering each block of time and pressure controlled puffs of air to the pharynx or larynx region, with a rest period between blocks of about 30 seconds; and

outputting a stimulus output signal when the controlled puff of air is delivered.

9. A method for testing pharyngeal and supraglottic sensation in a patient at a test site in the pharynx or larynx region, comprising:

inserting a first outlet end of a Y-shaped tube into one of the patient'"'"'s nasal passage and oral passage adjacent the test site;

delivering a time and pressure controlled puff of air to an inlet end of the Y-shaped tube;

measuring the air pressure at a second outlet end of the Y-shaped tube;

displaying the measured air pressure; and

outputting a stimulus output signal when the controlled puff of air is delivered.

10. An apparatus for testing sensation in a patient at a test site, comprising:

a Y-shaped tube with an inlet branch having an inlet end and first and second outlet branches having respective first and second outlet ends;

the first outlet branch of the Y-shaped tube being inserted into one of the patient'"'"'s nasal passage and oral passage, the first outlet end terminating adjacent the test site;

a pressure transducer connected to the second outlet branch of the Y-shaped tube, axially aligned with the second outlet end;

means for delivering a time and pressure controlled puff of air detachably connected to the inlet end of the Y-shaped tube; and

display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer.

11. The apparatus of claim 10, wherein the first and second outlet branches are substantially the same length.

12. The apparatus of claim 11, wherein the means for delivering a time and pressure controlled puff of air to the inlet end of the Y-shaped tube further comprises:

a source of high pressure air;

a pressure regulator receiving the high pressure air;

a valve, connected between the pressure regulator and the inlet end of the Y-shaped tube, receiving regulated air from the pressure regulator; and

means for controllably driving the valve to open and closed positions.

13. The apparatus of claim 12, wherein the means for controllably driving the valve to open and closed positions further comprises:

a trigger circuit producing trigger signals;

a valve driver producing drive signals responsive to the trigger signals input from the trigger circuit; and

an electrically controlled valve, the open or closed state of which is responsive to drive signals input from the valve driver.

14. The apparatus of claim 13, wherein the trigger circuit produces variable duration trigger signals.

15. The apparatus of claim 14, wherein the display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer further comprises a transducer circuit responsive to input from the pressure transducer and a display responsive to input from the transducer circuit.

16. The apparatus of claim 15, wherein the display is a Light Emitting Diode display.

17. An apparatus for testing sensation in a patient at a test site, comprising:

a flexible fiberoptic telescope having a distal end adapted to be located adjacent the test site;

a Y-connector with an inlet end and first and second outlet ends;

a delivery tube with an inlet end and an outlet end, the delivery tube being detachably attached to the fiberoptic telescope with the outlet end of the delivery tube adjacent the distal end of the fiberoptic telescope and the inlet end of the delivery tube extending outside the patient and being detachably attached to the first outlet end of the Y-connector;

a pressure transducer;

a sensor tube with an inlet end and an outlet end, the sensor tube inlet end being connected to the second outlet end of the Y-connector and the sensor tube outlet end being connected to the pressure transducer;

means for delivering a time and pressure controlled puff of air to the inlet end of the Y-connector; and

display means responsive to the pressure transducer for displaying a valve of pressure detected by the transducer.

18. A method for testing sensation in a patient at a test site, comprising:

locating a first outlet end of a Y-shaped tube adjacent the test site;

delivering a time and pressure controlled puff of air to an inlet end of the Y-shaped tube;

measuring the air pressure at a second outlet end of the Y-shaped tube; and

displaying the measured air pressure.

19. The apparatus of claim 18, wherein the delivery tube and the sensor tube are substantially the same length.

20. The method for testing sensation in a patient at a test site of claim 18, wherein the step of locating the first outlet end of the Y-shaped tube adjacent the test site further comprises locating the first outlet end of the Y-shaped tube about 2 mm from the test site.

21. The method for testing sensation in a patient at a test site of claim 20, wherein the step of delivering a time and pressure controlled puff of air to an inlet end of the Y-shaped tube further comprises delivering a plurality of time and pressure controlled puffs of air, each of varying pressure, to the inlet end of the Y-shaped tube.

22. An apparatus for testing sensation in a patient at a test site, comprising:

a flexible fiberoptic telescope with an input port at a first end and an output port at a second end, said input port being in communication with said output port;

said flexible fiberoptic telescope being adapted to have its second end terminating adjacent the test site;

a Y-connector with an inlet end and first and second outlet ends;

a delivery tube with an inlet end and an outlet end, the outlet end of the delivery tube being attached to the input port of the flexible fiberoptic telescope and the inlet end of the delivery tube being attached to the first outlet end of the Y-connector;

a pressure transducer;

a sensor tube with an inlet end and an outlet end, the sensor tube inlet end being connected to the second outlet end of the Y-connector and the sensor tube outlet end being connected to the pressure transducer;

means for delivering a time and pressure controlled puff of air to the inlet end of the Y-connector; and

display means responsive to the pressure transducer for displaying a value of pressure detected by the transducer.

23. The apparatus of claim 22, wherein the flexible fiberoptic telescope further comprises an insertion tube section at its second end detachably connected to a base section at its proximal end, whereby the insertion tube section is adapted to be located at the test site.

24. The apparatus of claim 23, further comprising a flexible sheath for covering at least a part of the flexible fiberoptic telescope.

25. The apparatus of claim 24, wherein the flexible sheath is formed as part of the detachable insertion tube section.

26. The apparatus of claim 25, wherein the distance from the input port of the flexible fiberoptic telescope to the output port of the flexible fiberoptic telescope added to the length of the delivery tube substantially equals the length of the sensor tube.

27. A method for testing sensation in a patient at a test site, comprising:

connecting a first outlet end of a Y-shaped tube to an input end of an insertion tube section of a flexible fiberoptic telescope;

locating the insertion tube section of the flexible fiberotic telescope so that an output end of the insertion tube section is adjacent the test site;

delivering a time and pressure controlled puff of air to an inlet end of the Y-shaped tube;

measuring the air pressure at a second outlet end of the Y-shaped tube; and

displaying the measured air pressure.

28. The method for testing sensation in a patient at a test site of claim 27, wherein the step of locating the insertion tube section of the flexible fiberoptic telescope so that an output end of the insertion tube section is adjacent the test site further comprises locating the insertion tube section so that the output end of the insertion tube section is about 2 mm from the test site.

29. The method for testing sensation in a patient at a test site of claim 28, wherein the step of delivering a time and pressure controlled puff of air to an inlet end of the Y-shaped tube further comprises delivering a plurality of time and pressure controlled puffs of air, each of varying pressure.