Establishment of therapies for pharyngeal dysphagia-Botulinum toxin injection therapy and functional electrical stimulation-

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We evaluated the effectiveness of a cricopharyngeal block using a local anesthetic agent in advance and administered BTX-A injections in various patients with dysphagia. The criteria for this study were : (1) patients with a history of dysphagia who did not improve with conventional swallowing therapy after more than 3 months, (2) oropharyngeal dysphagia in which UES dysfunction appeared to be the primary cause based on videofluorography. A percutaneous lidocaine injection into the cricopharyngeal muscle was first administered in patients who met the above criteria in order to determine the application of BTX-A injections. In cases where the lidocaine injection was judged to improve the passage of bolus in the area of UES using videofluorography, the patients then received a BTX-A injection. Thirty-nine patients met the criteria for the lidocaine injection. The BTX-A injection was done for 28 patients(72%). In 26 patients out of this group(93%), the passage of bolus improved in the area of UES at 1 month after the BTX-A injection. BTX-A is a very effective treatment in selected patients. A local anesthetic agent trial may predict the effectiveness of BTX-A injection.From the viewpoint of functional electric stimulation(FES), we investigated a surface electrode stimulation method to support laryngeal elevation in helthy subjects and patients with pharyngeal dysphagia. Informed consent was obtained from 15 healthy men and 4 patients with pharyngeal dysphagia. Digastric and stylohyoid muscles were stimulated by silver-textile surface electrodes covering the muscle belly. Laryngeal elevation by the electrical stimulation(ES) during liquid(water, 3ml) swallowing movement was measured by digital video camera. Laryngeal elevation by ES was 76% in the healthy subjects and 87% in patients when measured during liquid swallowing. Applying FES for laryngeal elevation may assist in improving the swallowing reflex.