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Objective:To observe the rehabilitative effect of combining respiratory function training with balloon dilatation for persons with cricopharyngeal achalasia after radiotherapy for nasopharyngeal carcinoma.Methods:A total of 120 nasopharyngeal carcinoma patients with cricopharyngeal achalasia after radiotherapy were randomly divided into an observation group and a control group, each of 60. Both groups were treated with routine functional swallowing training and balloon dilatation, while the observation group was additionally provided with respiratory function training 5 days a week for 8 weeks. Before the treatment and after 4 and 8 weeks of treatment, the swallowing function of both groups was evaluated using video fluoroscopy (VFSS), a functional oral intake scale (FOIS), cricopharyngeal muscle functional status and the M. D. Anderson dysphagia inventory (MDADI).Results:After 4 weeks of treatment the average VFSS, FOIS and MDADI scores of both groups were significantly better than before the treatment, and significant improvement continued over the subsequent four weeks. After 8 weeks of treatment, the average VFSS, FOIS and MDADI scores of the observation group had again improved significantly. Physiology, functioning, and their emotional state were also adjudged to have improved compared with 4 weeks earlier and compared with the control group.Conclusion:Combining respiratory function training with balloon dilatation can improve swallowing and can significantly reduce or delay swallowing disorders among patients with cyclopharyngeal achalasia after radiotherapy.
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Objective To explore the characteristics and mechanisms of dysphagia in patients with dorsola-teral medullary syndrome ( DMS). Methods Twelve DMS patients were evaluated clinically and submitted to videofluoroscopic study in order to investigate clinical manifestations and the pathophysiological changes in swallowing. Swallowing function was recorded at discharge and during a three-month follow-up period. Results All patients had difficulties in swallowing and drinking, presenting coughing and throat clearing, and needed nasogastric feeding at admission. Insufficient soft palate elevation was observed in seven patients, who had no other oral phase dysfunction. The pharyngeal phase was injured in all patients. Decreased larynx elevation and invalid swallowing were observed in 10 patients. Delayed pharyngeal swallowing was seen in 8 patients. Under videofluoroscopy, 9 patients showed significantly decreased larynx elevation. Ten patients opened the cricopharyngeal muscles insufficiently, while two could not open at all. Larynx penetration was seen in all patients. Eleven patients were able to return to oral feeding, after 36 days on average (range 13 - 50 d). The patients with a disease history of 3 or more years could not return to oral feeding. Conclusion DMS patients are characterized by decreased larynx elevation and reduced compliance of the cricopharyngeal muscles. Early therapy may provide patients with a good prognosis.