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Evaluation of Hypopharyngeal Suction to Eliminate Aspiration: The Retro-Esophageal Suction (REScue) Catheter

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Abstract

Profound oropharyngeal dysphagia (OPD) is common and costly. Treatment options are limited. The purpose of this investigation was to evaluate the utility of hypopharyngeal suction at the upper esophageal sphincter (UES) to eliminate aspiration. Five different catheters were passed retrograde up the esophagus and positioned at the UES in a cadaver model of profound OPD. Suction was affixed to each catheter. 10 cc of barium was administered into the pyriform sinus, and videofluoroscopy was utilized to evaluate the presence of aspiration. 6 trials were administered per catheter and for a no catheter control. The outcome measures were the incidence of aspiration, the NIH Swallow Safety Scale (NIH-SSS), and UES opening. Control trials with no suction resulted in an aspiration rate of 100 % (6/6 trials). Negative pressure through 16, 18, 24, and 30 Fr catheter resulted in an aspiration rate of 0 % (0/24 trials; p < 0.001), and suction through a 12-Fr catheter resulted in an aspiration rate of 33 % (2/6 trials; p > 0.05). The mean NIH-SSS improved from 7.0 (±0.0) in the control to 0 (±0.0) with hypopharyngeal suction (18 Fr nasogastric catheter; p < 0.001). Mean UES opening improved from 0.0 (±0.0) mm in the control condition to 8.6 (±0.2) mm with a hypopharyngeal catheter (16 Fr Foley catheter; p < 0.001). Negative pressure applied through retro-esophageal suction catheters (>12 Fr) at the level of the UES reduced aspiration by 100 % and significantly increased UES opening in a cadaveric model of profound oropharyngeal dysphagia.

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References

  1. Wang X, You G, Chen H, Cai X. Clinical course and cause of death in elderly patients with idiopathic Parkinson’s disease. Chin Med J (Engl). 2002;115(9):1409–11.

    Google Scholar 

  2. Kalia M. Dysphagia and aspiration pneumonia in patients with Alzheimer’s disease. Metabolism. 2003;52(10 Suppl 2):36–8.

    Article  CAS  PubMed  Google Scholar 

  3. Martino R, Foley N, Bhogal S, Diamant N, Speechley M, Teasell R. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke. 2005;36(12):2756–63.

    Article  PubMed  Google Scholar 

  4. Mok P, Woo P, Schaefer-Mojica J. Hypopharyngeal pharyngoplasty in the management of pharyngeal paralysis: a new procedure. Ann Otol Rhinol Laryngol. 2003;112(10):844–52.

    Article  PubMed  Google Scholar 

  5. Fayoux P, Bonne NX, Hosana G. Hypopharyngeal pharyngoplasty in the treatment of severe aspiration following skull base tumor removal. Arch Otol Rhinol Laryngol. 2011;137(1):60–4.

    Google Scholar 

  6. Lindeman RC. Diverting the paralyzed Larynx: a reversible procedure for intractable aspiration. Laryngoscope. 1975;85(1):157–80.

    Article  CAS  PubMed  Google Scholar 

  7. Baron BC, Dedo HH. Separation of the larynx and trachea for intractable aspiration. Laryngoscope. 1980;90(12):1927–32.

    Article  CAS  PubMed  Google Scholar 

  8. Remacle M, Marza L, Lawson G. A new epiglottoplasty procedure for the treatment of intractable aspiration. Eur Arch Otorhinolaryngol. 1998;255:64–7.

    Article  CAS  PubMed  Google Scholar 

  9. Eibling DE, Snyderman CH, Eibling C. Laryngotracheal Separation for Intractable Aspiration: A Retrospective of Review of 34 Patients. Laryngoscope. 1995;105:83–5.

    Article  CAS  PubMed  Google Scholar 

  10. Cook SP. Candidate’s thesis: laryngotracheal separation in neurologically impaired children: long-term results. Laryngoscope. 2009;119:390–5.

    Article  PubMed  Google Scholar 

  11. Bhattacharyya N, Kotz T, Shapiro J. Dysphagia and aspiration with unilateral vocal cord immobility: incidence, characterization, and response to surgical treatment. Ann Otol Rhino Laryngo. 2002;111:672–9.

    Article  Google Scholar 

  12. Kos MP, David EF, Aalders IJ, Smith CF, Mahieu HF. Long-term results of laryngeal suspension and upper esophageal sphincter myotomy as treatment for life-threatening aspiration. Ann Otol Rhinol Laryngol. 2008;117(8):574–80.

    Article  PubMed  Google Scholar 

  13. Steele CM, Bailey GL, Chau T, Molfenter SM, Oshalla M, Waito AA, Zoratto DC. The relationship between hyoid and laryngeal displacement and swallowing impairement. Clin Otolaryngol. 2011;36(1):30–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  14. Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol. 2004;113(2):87–92.

    Article  PubMed  Google Scholar 

  15. Cerenko D, McConnel FM, Jackson RT. Quantitative assessment of pharyngeal bolus driving forces. Otolaryngol Head Neck Surg. 1989;100(1):57–63.

    CAS  PubMed  Google Scholar 

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Correspondence to Peter C. Belafsky.

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Belafsky, P.C., Mehdizadeh, O.B., Ledgerwood, L. et al. Evaluation of Hypopharyngeal Suction to Eliminate Aspiration: The Retro-Esophageal Suction (REScue) Catheter. Dysphagia 30, 74–79 (2015). https://doi.org/10.1007/s00455-014-9576-z

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