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

我们评估了预先使用局部麻醉剂的环咽阻滞的效果，并在不同的吞咽困难患者中注射了BTX-A。这项研究的标准是：(1)有吞咽困难病史的患者，经过3个月以上的常规吞咽治疗后没有改善；(2)口咽吞咽困难，根据视频透视，UES功能障碍似乎是主要原因。首先对符合上述标准的患者进行经皮利多卡因环咽肌注射，以确定BTX-A注射的应用。在使用视频荧光摄影判断利多卡因注射改善UES区域团注通道的情况下，患者随后接受BTX-A注射。39名患者符合利多卡因注射的标准。BTX-A注射治疗28例(72%)。其中26例(93%)在注射BTX-A后1个月时，UES区的团注通道改善。BTX-A对选定的患者是一种非常有效的治疗方法。局部麻醉剂试验可以预测注射BTX-A的效果。从功能性电刺激(FES)的角度，我们研究了一种表面电极刺激方法，以支持健康受试者和咽部吞咽困难患者的喉部抬高。15名健康男性和4名咽部吞咽困难患者获得知情同意。用覆盖在肌腹上的银质表面电极刺激二腹肌和茎突舌骨肌。用数码摄像机测量吞咽液体(水，3ml)时电刺激(ES)引起的喉头抬高。当在液体吞咽时测量时，ES的喉部抬高在健康人中为76%，在患者中为87%。应用FES抬高喉部可能有助于改善吞咽反射。

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.