Skip to main content

Advertisement

SpringerLink
Log in

Botulinum Toxin A Injection Using Esophageal Balloon Radiography Combined with CT Guidance for the Treatment of Cricopharyngeal Dysphagia

  • Original Article
  • Published:
Dysphagia Aims and scope Submit manuscript

Abstract

Cricopharyngeal dysfunction, especially cricopharyngeal achalasia, is a common cause of dysphagia, while patients with brainstem stroke and medullary damage have a relatively high risk of cricopharyngeal achalasia. The aim of this article was to introduce an improved method of CT-guided method of injecting botulinum toxin A into the cricopharyngeus muscle using esophageal balloon radiography, and to assess the effect of the botulinum toxin A injection on swallowing performance. Seventeen patients with cricopharyngeal dysphagia were treated with botulinum toxin A injection using esophageal balloon radiography combined with CT guidance to the cricopharyngeal muscle. Primary outcome measures, including Functional Oral Intake Scale and Deglutition Handicap Index, were performed at baseline, 1 week, and 1 month after treatment. The Levene method was used to test the homogeneity of variance, and the Kruskal–Wallis test was used to compare the scores between the timepoints. Botulinum toxin A injection resulted in obvious improvement in 15 patients (88.2%) and no improvement in two patients (11.8%). Compared with the scores prior to treatment, the Functional Oral Intake Scale and Deglutition Handicap Index scores were significantly improved at 1 week (P < 0.001 and P = 0.008, respectively) and 1 month after the treatment (P = 0.001 and P < 0.001, respectively). Thus, CT-guided percutaneous injection of botulinum toxin A is probably a relatively safe, well-tolerated, and viable technique for the treatment of cricopharyngeal dysphagia caused by brainstem injury. Localization with a balloon radiography made the needle guidance easier to visualize.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Huoh KC, Messner AH. Cricopharyngeal achalasia in children: indications for treatment and management options. Curr Opin Otolaryngol Head Neck Surg. 2013;21(6):576–80.

    PubMed  Google Scholar 

  2. Marchica C, Zawawi F, Daniel SJ. Management of cricopharyngeal achalasia in an 8-month child using endoscopic cricopharyngeal myotomy. Int J Pediatr Otorhinolaryngol. 2017;101:137–40.

    Article  Google Scholar 

  3. Ashman A, Dale OT, Baldwin DL. Management of isolated cricopharyngeal dysfunction: systematic review. J Laryngol Otol. 2016;130(7):611–5.

    Article  CAS  Google Scholar 

  4. Regan J, Murphy A, Chiang M, McMahon BP, Coughlan T, Walshe M: Botulinum toxin for upper oesophageal sphincter dysfunction in neurological swallowing disorders. Cochrane Database Syst Rev. 2014; 5:CD009968.

  5. Bian RX, Choi IS, Kim JH, Han JY, Lee SG. Impaired opening of the upper esophageal sphincter in patients with medullary infarctions. Dysphagia. 2009;24(2):238–45.

    Article  Google Scholar 

  6. Steinhagen V, Grossmann A, Benecke R, Walter U. Swallowing disturbance pattern relates to brain lesion location in acute stroke patients. Stroke. 2009;40(5):1903–6.

    Article  Google Scholar 

  7. Yang H, Yi Y, Han Y, Kim HJ. Characteristics of cricopharyngeal dysphagia after ischemic stroke. Ann Rehabil Med. 2018;42(2):204–12.

    Article  Google Scholar 

  8. Schneider I, Thumfart WF, Pototschnig C, Eckel HE. Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method. Ann Otol Rhinol Laryngol. 1994;103(1):31–5.

    Article  CAS  Google Scholar 

  9. Atkinson SI, Rees J. Botulinum toxin for cricopharyngeal dysphagia: case reports of CT-guided injection. J Otolaryngol. 1997;26(4):273–6.

    CAS  PubMed  Google Scholar 

  10. Woisard V, Andrieux MP, Puech M. Validation of a self-assessment questionnaire for swallowing disorders (Deglutition Handicap Index). Rev Laryngol Otol Rhinol (Bord). 2006;127(5):315–25.

    CAS  Google Scholar 

  11. Parameswaran MS, Soliman AM. Endoscopic botulinum toxin injection for cricopharyngeal dysphagia. Ann Otol Rhinol Laryngol. 2002;111(10):871–4.

    Article  Google Scholar 

  12. Alberty J, Oelerich M, Ludwig K, Hartmann S, Stoll W. Efficacy of botulinum toxin A for treatment of upper esophageal sphincter dysfunction. Laryngoscope. 2000;110(7):1151–6.

    Article  CAS  Google Scholar 

  13. Murry T, Wasserman T, Carrau RL, Castillo B. Injection of botulinum toxin A for the treatment of dysfunction of the upper esophageal sphincter. Am J Otolaryngol. 2005;26(3):157–62.

    Article  CAS  Google Scholar 

  14. Woisard-Bassols V, Alshehri S, Simonetta-Moreau M. The effects of botulinum toxin injections into the cricopharyngeus muscle of patients with cricopharyngeus dysfunction associated with pharyngo-laryngeal weakness. Eur Arch Otorhinolaryngol. 2013;270(3):805–15.

    Article  Google Scholar 

  15. Zarate N, Mearin F, Baldovino F, Armengol JR, Malagelada JR. Achalasia treatment in the elderly: is botulinum toxin injection the best option? Eur J Gastroenterol Hepatol. 2002;14(3):285–90.

    Article  Google Scholar 

  16. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med. 1995;332(12):774–8.

    Article  CAS  Google Scholar 

  17. Terre R, Panades A, Mearin F. Botulinum toxin treatment for oropharyngeal dysphagia in patients with stroke. Neurogastroenterol Motil. 2013;25(11):896–e702.

    Article  CAS  Google Scholar 

  18. Dunne J, Hayes M, Cameron D. Botulinum toxin A for cricopharyngeal dystonia. Lancet. 1993;342(8870):559.

    Article  CAS  Google Scholar 

  19. Jeong SH, Kim YJ, Kim YJ, Park KD, Kim EJ, Chung JW, Kwon KA, Kim KO, Park DK, Kim JH, et al. Endoscopic botulinum toxin injection for treatment of pharyngeal dysphagia in patients with cricopharyngeal dysfunction. Scand J Gastroenterol. 2018;53(10–11):1201–5.

    Article  CAS  Google Scholar 

  20. Kelly EA, Koszewski IJ, Jaradeh SS, Merati AL, Blumin JH, Bock JM. Botulinum toxin injection for the treatment of upper esophageal sphincter dysfunction. Ann Otol Rhinol Laryngol. 2013;122(2):100–8.

    Article  Google Scholar 

  21. Kocdor P, Siegel ER, Tulunay-Ugur OE. Cricopharyngeal dysfunction: A systematic review comparing outcomes of dilatation, botulinum toxin injection, and myotomy. Laryngoscope. 2016;126(1):135–41.

    Article  CAS  Google Scholar 

  22. Moerman MB. Cricopharyngeal Botox injection: indications and technique. Curr Opin Otolaryngol Head Neck Surg. 2006;14(6):431–6.

    Article  Google Scholar 

  23. Kim DY, Park CI, Ohn SH, Moon JY, Chang WH, Park SW. Botulinum toxin type A for poststroke cricopharyngeal muscle dysfunction. Arch Phys Med Rehabil. 2006;87(10):1346–51.

    Article  Google Scholar 

  24. Ravich WJ. Botulinum toxin for UES dysfunction: therapy or poison? Dysphagia. 2001;16(3):168–70.

    Article  CAS  Google Scholar 

  25. Haapaniemi JJ, Laurikainen EA, Pulkkinen J, Marttila RJ. Botulinum toxin in the treatment of cricopharyngeal dysphagia. Dysphagia. 2001;16(3):171–5.

    Article  CAS  Google Scholar 

  26. Shaw GY, Searl JP. Botulinum toxin treatment for cricopharyngeal dysfunction. Dysphagia. 2001;16(3):161–7.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

This study was supported by Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University and Department of Spinal Surgery, Armed Police Corps Hospital of Shandong Province, China.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Qilu Hospital of Shandong University, Jinan, China

    Juan Huai, Yang Zhang, Yonghui Wang, Xiuying Zhang, Yanyan Zhang & Shouwei Yue

  2. Department of Rehabilitation Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China

    Ying Hou

  3. Department of Spinal Surgery, Armed Police Corps Hospital of Shandong Province, Jinan, China

    Jiawen Guan

Authors
  1. Juan Huai
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ying Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiawen Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yang Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yonghui Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiuying Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yanyan Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shouwei Yue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shouwei Yue.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huai, J., Hou, Y., Guan, J. et al. Botulinum Toxin A Injection Using Esophageal Balloon Radiography Combined with CT Guidance for the Treatment of Cricopharyngeal Dysphagia. Dysphagia 35, 630–635 (2020). https://doi.org/10.1007/s00455-019-10070-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00455-019-10070-5

Keywords

Search

Navigation