Ann Rehabil Med.  2017 Apr;41(2):231-238. 10.5535/arm.2017.41.2.231.

Effect of Vallecular Ballooning in Stroke Patients With Dysphagia

• Kim YK
• Lee SH
• Lee JW

• KMID: 2389481
• DOI: http://doi.org/10.5535/arm.2017.41.2.231

Abstract

OBJECTIVE
To investigate the improvement of dysphagia after balloon dilatation and balloon swallowing at the vallecular space with a Foley catheter in stroke patients.
METHODS
This study was conducted between May 1, 2012 and December 31, 2015, and involved 30 stroke patients with complaints of difficulty in swallowing. All patients underwent videofluoroscopic swallowing study (VFSS) before and after vallecular ballooning. VFSS was performed with a 4 mL semisolid bolus. For vallecular ballooning, two trainings were performed for at least 10 minutes, including backward stretching of the epiglottis and swallowing of a balloon located in the vallecular space, by checking the movement of the Foley catheter tip in real time using VFSS.
RESULTS
After examination of the dysphagia improvement pattern before and after vallecular ballooning, laryngeal elevation (x-axis: pre 2.62±1.51 mm and post 3.54±1.93 mm, p=0.038; y-axis: pre 17.11±4.24 mm and post 22.11±3.46 mm, p=0.036), pharyngeal transit time (pre 5.76±6.61 s and post 4.08±5.49 s, p=0.043), rotation of the epiglottis (pre 53.24°±26.77° and post 32.45°±24.60°, p<0.001), and post-swallow pharyngeal remnant (pre 41.31%±23.77% and post 32.45%±24.60%, p=0.002) showed statistically significant differences. No significant difference was observed in the penetration-aspiration scale score (pre 4.73±1.50 and post 4.46±1.78, p=0.391).
CONCLUSION
For stroke patients with dysmotility of the epiglottis and post-swallowing residue, vallecular ballooning can be considered as an alternative method that can be applied without risk of aspiration in dysphagia treatment.

Keyword

Stroke; Deglutition disorder; Fluoroscopy; Epiglottis

MeSH Terms

Catheters
Deglutition
Deglutition Disorders*
Dilatation
Epiglottis
Fluoroscopy
Humans
Methods
Stroke*

Figure

• 

  Fig. 1 Vallecular ballooning. Contrast medium was injected into the balloon after inserting the tip into the vallecular space by checking the movement of the tip of the Foley catheter in real time using videofluoroscopic swallowing study. Two kinds of training were performed: backward stretching of the epiglottis (A) and swallowing of a balloon located in the vallecular space (B).

• 

  Fig. 2 Laryngeal elevation. The zero point was defined as the anterior-inferior margin of the 4th cervical vertebral body, the y-axis as the straight line connecting the zero point with the anterior-inferior margin of the second cervical vertebral body, and the x-axis as the line perpendicular to the y-axis. Hyoid bone at the position of the resting state (A) and most highly raised position during swallowing (B).

• 

  Fig. 3 Post-swallow pharyngeal remnant. The difference in the remnant (%) was measured before and after swallowing, using an AutoCAD 2D screen. Remnant before swallowing (A) and remnant after swallowing (B).

• 

  Fig. 4 Epiglottis rotation. The maximum angle change in the line connecting the root with the tip of the epiglottis before and after swallowing was measured. To reduce error, a straight line linking the anterior-inferior margin of the 4th vertebral body and the anterior-inferior margin of the 2nd vertebral body was used as a baseline. Before swallowing (A) and maximum angle during swallowing (B).

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