Comparison studies of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in the treatment of neurogenic cricopharyngeal muscle dysfunction

BACKGROUND: Cricopharyngeal muscle dysfunction (CPD) management has been challenging in clinical practice. OBJECTIVE: To compare the efficacy and safety of ultrasound-guided botulinum toxin injection and balloon catheter dilatation in treating CPD. METHODS: Forty patients with CPD were randomly divided into two groups, namely the botulinum toxin injection group (BTX group) and balloon dilatation group (BD group). Patients in the BTX group received a single ultrasound-guided injection of 50 units of botulinum toxin type A, while the BD group received dilatation therapy five times per week, consecutively for two weeks. Relative opening percentage of the upper esophageal sphincter (UES), the penetration-aspiration scale (PAS), and the Dysphagia Outcome Severity Scale (DOSS) were evaluated by a videofluoroscopic swallowing study (VFSS) at baseline, 1-month, and 3-months posttreatment. The Functional Oral Intake Scale (FOIS) and Standardized Swallowing Assessment (SSA) were also used to evaluate participants’ swallowing function at baseline and the 1-week, 2-week, 1-month, and 3-month follow-ups. RESULTS: A generalized estimating equation (GEE) model revealed the significant main effect for time in UES, PAS, DOSS, FOIS, and SSA compared to baseline (P <0.05), while no group-by-time interactions (except for the PAS assessment) or main effect for treatment was detected among the above multiple variances. No systematic complications or severe adverse effects were noted. CONCLUSION: Both ultrasound-guided botulinum toxin type A injections and balloon dilatation therapy have been proven as safe and effective treatments for CPD patients. Future clinical trials with longer follow-up periods and more participants are warranted.

Balloon Catheter Dilatation for Treatment of a Patient With Cricopharyngeal Dysfunction After Thermal Burn Injury

Deglutition disorder is a clinical symptom that has been associated with inhalation and cutaneous thermal burn injuries. Deglutition disorder is present in approximately 11% of patients with burn injury and is known to persist for weeks to months postinjury. Here, we report a case of deglutition disorder associated with cricopharyngeal dysfunction in a patient with thermal burn injury. Two patients presented with deglutition disorder lasting for several weeks after thermal injury. Clinically, it manifested as combined liquid and solid food dysphagia. The findings of videofluoroscopic swallow study (VFSS) were poor relaxation of the pharyngoesophageal sphincter (PES), decreased elevation of the laryngohyoid, and inadequate pharyngeal contraction. The PES was dilated with a 20-mm expansion balloon catheter multiple times. The symptoms of deglutition disorder were relieved immediately after the procedure. Balloon catheter dilatation was performed four times at 1- to 2-week intervals. Follow-up VFSS showed that poor relaxation of the PES was improved. The VFSS showed no recurrence at the 3-month follow-up. We found that balloon catheter dilatation for treatment of a patient with cricopharyngeal dysfunction after thermal burn injury was effective, ease of use, and safe.

Sinus Balloon Dilation as Treatment for Acute Sphenoid Sinusitis with Impaired Vision for a Child

This paper is about sinus balloon dilatation in treatment of acute left sphenoid sinusitis with left impaired vision in a child. Balloon catheter dilatation (BCD) of the sinus ostia is a new technique. It has been shown to be a minimally invasive technique to manage chronic sinusitis. However, this method is rarely used in the treatment of acute sinusitis. So far, we know of no reported cases of sinus balloon dilatation in treatment of this case, especially for children.