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Objective To explore the effect of the modified balloon dilatation on excitability of the submental swallowing muscle and its relationship with swallowing function of dysphagic patients with brainstem stroke.Methods Thirty unilateral brainstem stroke patients with upper esophageal sphincter (UES) dysfunction were recruited and randomly divided into a dilatation group and a control group,each of 15.The control group was given the routine swallowing therapy twice daily,while the dilatation group was provided one routine swallowing treatment plus a modified balloon dilatation daily.The treatment lasted 3 weeks,30min per day and 5 days per week.Both groups were evaluated using the bilateral submental motor evoked potentials (SMEPs),penetration-aspiration scale (PAS) and functional oral intake scale (FOIS) before and after treatment.Results Repeated analysis of variance showed that there was significant interaction effect of group,time on SMEPs.The MEPs of the affected submental muscle increased significantly in both groups after treatment (P＜0.01),but only the amplitude of SMEP of the affected submental muscles in the dilatation group was higher than that of the control group after treatment (P＜0.05).In the dilatation group,the average FOIS score increased significantly (P＜0.01),while the average PAS score decreased significantly after the treatment (P＜0.05).An increase of amplitude of the affected SMEP was strongly correlated with the improvement in the average PAS score (P＜0.01,r=0.815),but weakly correlated with the average FOIS score (P =0.02,r =0.43).Conclusion The modified balloon dilatation therapy can increase the excitability of the cortical-affected lateral brainstem-swallowing muscle pathway in patients with unilateral brainstem stroke,which might be more correlated with improvement in swallowing safety.
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Objective To explore the effects of modified balloon dilatation therapy for treating upper esophageal sphincter dysfunction after a brainstem stroke.Methods Ten healthy adult volunteers and 20 dysphagic patients with upper esophageal sphincter dysfunction after a brainstem stroke were recruited.The 20 patients were divided into a balloon dilatation therapy group of ten who were treated with catheter balloon dilatation therapy, and a control group of ten who received conventional therapy.All were given block-designed task fMRI scans guided by a matched visual presentation system before and after the treatment.Results Widespread activation was observed in both hemispheres, including the bilateral cerebral cortex, the brainstem and the cerebellum, but the activated areas were significantly smaller in the stroke patients before treatment.After the treatment, seven patients in the balloon dilatation group were totally orally fed, while only three patients in the control group recovered totally oral intake.After dilatation, significantly more regions were activated, including the anterior cingulate, insula, supplementary motor area, precuneus and the frontal lobe.They were activated with relatively low voxels in the treatment group, while in the control group significant activation was observed only in the precuneus after treatment.Conclusion Modified balloon dilatation therapy can increase activation of the cortex and subcortical structures related to swallowing, promoting better swallowing function.
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Objective To investigate the effect of different intervention times on the efficacy of catheter balloon dilatation therapy for cricopharyngea] achalasia after stroke.Methods Forty-eight cases diagnosed as cricopharyngeal achalasia were divided into 4 groups,groups A,B,C,and D according to the time of intervention from the onset (i.e.0.5,0.5-1,1-3,and 3-6 months),with 12 cases in each group.A 14# urethral catheter was inserted into the esophagus and water was injected into the balloon to make it turgid.The catheter was then pulled upwards through the stricture in the esophagus to dilatate the cricopharygeal muscle.The patients also received low frequency electrical stimulation combined with dysphagia rehabilitation behavioral therapy once daily.The treatment end point was either when the patient resumed an oral diet or after 6 weeks of treatment.The effects of the treatment were evaluated in terms of the number of times the dilatation therapy was administered,the pharyngeal transit duration,swallowing function and fluoroscopic examination before and after treatment.Results Groups A,B and C required significantly fewer treatment sessions than group D.Groups A and B required significantly fewer sessions than group C,but the difference between groups A and B was not statistically significant.After treatment,there were 11 patients can eat water,liquid,paste and solid food both in groups A and B.But the number of patients who can eat the4 traits of food was 9,9,10,9 in group C and 6,6,7,5 in group D respectively.Swallowing function in groups A,B and C was adjudged,on average,significantly better than in group D.Compared with group C,swallowing function in groups A and B was also significantly improved,but the difference between groups A and B was not statistically significant.The pharyngeal transit duration in all 4 groups was shorter than before treatment,but the duration in groups A,B and C was significantly shorter than in group D.Compared with group C,the pharyngeal transit duration in groups A and B was significantly shorter,but the difference between groups A and B was again not statistically significant.Fluoroscopy showed the efficiency in groups A and B to be over 91 ％.In group C it was 83％ and in group D 58％.The difference between group D and groups A,B and C was significant.The efficiency in groups A and B was significantly better than in group C,but the difference between groups A and B again was not statistically significant.Conclusions Early intervention using catheter balloon dilatation therapy can facilitate the improvement of swallowing function in patients with cricopharyngeal achalasia after stroke and improve their quality of life.
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Objective To investigate the effects of catheter balloon dilatation on patients with dysphagia caused by neurogenic cricopharyngeal achalasia.Methods Thirty-two patients with dysphagia caused by neurogenic cricopharyngeal achalasia were divided randomly into a treatment group (n =16) and a control group (n =16).The treatment group received catheter balloon dilatation therapy and routine dysphagia rehabilitation training; the control group was treated with routine dysphagia rehabilitation training only.Both groups were tested before treatment,after 3 weeks of treatment (after treatment) and at 6 months after treatment (follow-up).All cases were evaluated using Saitoh's 7-grade swallowing assessment and videofluoroscopy.Results After treatment,5 cases in the treatment group had been cured (31％) and 8 cases showed marked effectiveness (50％) ; in the control group,1 case was cured (7％) and 5 cases showed marked effectiveness (31％).These differences were statistically significant.At follow-up,5 cases in the treatment group had been cured (31％) and 9 cases showed marked effectiveness (56％) ; for the control group,1 case was cured (7％) and 6 cased showed marked effectiveness (38％).Those differences were also statistically significant.After treatment and also at follow-up,the average time for a bolus to pass the pharynx in the treatment group was significantly shorter than that in the control group.Conclusion Catheter balloon dilatation therapy is effective for treating neurogenic cricopharyngeal achalasia in both the short and long term.
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Objective To study the effect of low frequency electric stimulation and urethral catheter balloon dilatation therapy on dysphagia in nasopharyngeal carcinoma(NPC)patients after radiation therapy. Methods Eighteen dysphagic NPC patients who had received radiation therapy were studied.They included 15 males and 3 females with a mean age of 49.5 years.Thirteen were being fed with a nasogastric tube and 5 with a gastmstomy tube.Low frequency electric stimulation was applied to the swallowing muscles and urethral catheter balloon dilatation therapy was used for the crieopharygeus muscle.Before and after treatment the effects were evaluated with a videofluoroscopic study of swallowing.Results Most swallowing function improved after treatment.After treatment the pharyngeal transit time of paste iodine and fluid iodine(diatriazoate)through the mouth and hypopharynx showed significant improvement.Displacement of the hyoid bone was significantly greater after treatment.Before treatment the incidence of pyriform sinus stasis and aspiration were 100%:after treatment these were 44.4%and 16.6% respectively.Videofluoroscopy showed that 7 cases had been cured(38.9%),9 cases had improved(50.0%)and 2 cases showed no effect(11.1%).In 15 cases the nasogastric or gastrostomy tube could be removed. Conclusion Low frequency electric stimulation and urethral catheter balloon dilatation can improve swallowing in NPC patients with dysphagia after radiation therapy.This treatment was easy to administer,safe and reliable.
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Objective To investigate the efficacy of two different methods of catheter balloon dilatation therapy in treating cricopharyngeal achalasia and benign strictures,and to correlate balloon capacity with improve-ments in swallowing function. Methods Twenty-three cricopharyngeal achalasia patients and 7 with benign stric-tures of the cricopharyngeal muscles were diagnosed using videonuoroscopic swallowing study(VFSS).All cases re-ceived active dilatation or passive balloon dilatation therapy,combined with manipulation,indirect training,direct training and feeding instruction.Efficacy and the correlation were evaluated using VFSS and a swallowing function scale. Results Passive and active dilatation had the same efficacy.The correlation coefficient between balloon ca-pacity and swallowing function was 0.92 1.Re-evaluation using VFSS showed that opening of the cricopharyngeal muscles had improved significantly.Conclusions Balloon catheter dilation is an effective treatment for cricopha-ryngeal achalasia and benign strictures.The improvement in swallowing function is highly correlated with balloon ca-pacity in balloon dilatation therapy.Comprehensive treatment for dysphagia would provide better outcomes.
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Objective To study the effect of balloon dilatation therapy on dysphagia caused by cricopharyn- geal achalasia.Methods Ten cases of dysphagia were diagnosed as cricopharyngeal achalasia by videofluoroscopic swallowing study(VFSS).A 14~* urethral catheter was inserted into the esophagus and an amount of water was injec- ted into the balloon of the urethral catheter to make it turgid.Then the catheter was pulled upwards and passed through the stricture of esophagus to dilatate the cricopbarygeus muscle.Meanwhile,low frequency electrical stimula- tion was used and combined with functional training of the organs related to deglutition and ingestion.The results be- fore and after the treatment were evaluated.Results After 19.7 times of dilatation therapy,the content of water in- jected into the balloon was increased from 2.65?0.91 ml to 8.20?0.92 ml.Cricopharyngeal achalasia was alle- viated significantly(P