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Dog experiments have demonstrated that electrical stimulation delivered to denervated posterior cricoarytenoid muscles (PCA) can restore abduction and relieve airway obstruction. Experiments lasting up to 10 months have shown reversal of muscle atrophy by both functional and histologic criteria. The device, the Medtronic Ifrel II, consists of an implantable stimulator connected to electrodes that are surgically placed between the PCA muscle and the cricoid cartilage. The report presents the results from the first two patients implanted with Ifrel II for the condition of bilateral vocal fold paralysis (performed at the University Hospital, Antwerp, Belgium). Both patients are women (ages 60 and 77 years) with a history of thyroidectomy and were dependent on a tracheostomy for at least 4 months. In both patients, trials of electrical stimulation during initial surgical implantation resulted in noticeable abduction of the stimulated vocal fold. No surgical complications or dysphasia has been reported for either patient, although both patients demonstrate electrically induced coughing at high stimulation levels. Patients have been maintained on a conservative schedule of stimulation: frequency, 10–30 Hz; amplitude, 2–10 V; and a duty cycle of 1.5 sec on and 3.5 sec off. The patient with the longest implantation time (3 months) has increased her peak inspiratory flow to above 1.51/sec. At the time of this abstract submission two other centers (Johannes Guttenberg Universitat, Mainz, Germany, and Hennepin County Medical Center, Minneapolis, Minn.) have received governmental and hospital approval to implant the device. The results from patients who received the implant at all sites will be presented. Preoperative assessment, indications, stimulation protocols, and long-term results will be discussed.