Ann Rehabil Med.  2015 Aug;39(4):524-534. 10.5535/arm.2015.39.4.524.

Effectiveness of Rehabilitative Balloon Swallowing Treatment on Upper Esophageal Sphincter Relaxation and Pharyngeal Motility for Neurogenic Dysphagia

• Kim YK
• Choi SS
• Choi JH
• Yoon JG

• KMID: 2148222
• DOI: http://doi.org/10.5535/arm.2015.39.4.524

Abstract

OBJECTIVE
To investigate the relationship between dysphagia severity and opening of the upper esophageal sphincter (UES), and to assess the effect of balloon size on functional improvement after rehabilitative balloon swallowing treatment in patients with severe dysphagia with cricopharyngeus muscle dysfunction (CPD).
METHODS
We reviewed videofluoroscopic swallowing studies (VFSS) conducted in the Department of Physical Medicine and Rehabilitation, Myongji Hospital from January through December in 2012. All subjects diagnosed with CPD by VFSS further swallowed a 16-Fr Foley catheter filled with barium sulfate suspension for three to five minutes. We measured the maximum diameter of the balloon that a patient could swallow into the esophagus and subsequently conducted a second VFSS. Then, we applied a statistical technique to correlate the balloon diameter with functional improvement after the balloon treatment.
RESULTS
Among 283 inpatients who received VFSS, 21 subjects were diagnosed with CPD. It was observed that the degree of UES opening evaluated by swallowing a catheter balloon had inverse linear correlations with pharyngeal transit time and post-swallow pharyngeal remnant. Videofluoroscopy guided iterative balloon swallowing treatment for three to five minutes, significantly improved the swallowing ability in terms of pharyngeal transit time and pharyngeal remnant (p<0.005 and p<0.001, respectively). Correlation was seen between balloon size and reduction in pharyngeal remnants after balloon treatment (Pearson correlation coefficient R=-0.729, p<0.001), whereas there was no definite relationship between balloon size and improvement in pharyngeal transit time (R=-0.078, p=0.738).
CONCLUSION
The maximum size of the balloon that a patient with CPD can swallow possibly indicates the maximum UES opening. The iterative balloon swallowing treatment is safe without the risk of aspiration, and it can be an effective technique to improve both pharyngeal motility and UES relaxation.

Keyword

Oropharyngeal dysphagia; Upper esophageal sphincter; Cricopharyngeus muscle

MeSH Terms

Barium Sulfate
Catheters
Deglutition Disorders*
Deglutition*
Esophageal Sphincter, Upper*
Esophagus
Humans
Inpatients
Pharyngeal Muscles
Physical and Rehabilitation Medicine
Relaxation*
Barium Sulfate

Figure

• 

  Fig. 1 A video camera recorded the videofluoroscopic swallowing study at a speed of 30 frames per second. (A) shows the moment when the balloon starts to move down after laryngeal elevation during swallowing. (B) is the moment when the balloon (thick white arrow) passes through the upper esophageal sphincter (UES), which is approximately located at the level of the 4th and 5th cervical vertebrae. The cross-sectional diameter (dB) of the balloon at this moment divided by the longest diameter (dC) of the coin multiplied by 23 mm is the approximate balloon size at the UES.

• 

  Fig. 2 The pharyngeal transit time (PTT) is represented with respect to balloon size at the upper esophageal sphincter (UES), i.e., the degree of UES relaxation. (A) shows pre-treatment PTT versus maximum balloon size (□; Pearson correlation coefficient R=-0.560 and p=0.008) and post-treatment PTT versus maximum balloon size (▴; R=-0.671 and p=0.001). (B) shows post-treatment over pre-treatment PTT ratio versus treatment balloon size. All dots are scattered and there is no evidence of a relationship between PTT ratio and treatment balloon size (R=-0.078 and p=0.738).

• 

  Fig. 3 The post-swallow pharyngeal remnant is represented with respect to balloon size at the upper esophageal sphincter (UES), i.e. the degree of UES relaxation. (A) shows pre-treatment pharyngeal remnant versus maximum balloon size (□; Pearson correlation coefficient R=-0.523 and p=0.015) and post-treatment pharyngeal remnant versus maximum balloon size (▴; R=-0.704 and p<0.001). (B) shows post-treatment over pre-treatment ratio of pharyngeal remnant versus treatment balloon size. There is evidence of a statistically significant relationship between pharyngeal remnant ratio and treatment balloon size (R=-0.729 and p<0.001).

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