Abstract
Purpose: Head and neck cancer patients often experience swallowing disorders, impacting health and quality of life. This study examined effects of electrical stimulation to the pharynx on swallowing outcomes in post-surgical head and neck cancer patients. Methods: Swallowing was assessed using video fluoroscopy before, and 30 minutes after, a ten-minute application of electrical stimulation to the pharynx in five patients experiencing moderate-severe dysphagia. Corticopharyngeal motor projections were measured before and after stimulation of the pharynx using transcranial magnetic stimulation of motor cortex and measurements of motor evoked potentials (MEPs) in the striated muscle of the posterior pharyngeal wall. Results: Short-term changes in swallowing function were observed post-stimulation in: pharyngeal transit time, cricopharyngeal opening duration, total number of swallows, penetration/aspiration score, and duration of contact between the base of tongue and posterior pharyngeal wall. MEPs could not be measured in two participants. In the remaining participants, the MEP measures were not strongly associated with changes in observed swallowing function as has been found for neurogenic dysphagia. Conclusions: These findings indicated that somatosensory input, generated by electrical stimulation of the pharynx, changes swallowing function in head and neck cancer patients. These changes are not strongly correlated with alterations of corticopharyngeal excitability as previously observed in acutely dysphagic stroke patients.
Highlights
Oncologic interventions for head and neck cancer may include radiation, chemotherapy, surgical removal of affected tissues, or some combination of these
Four of the 5 participants showed pre-to-post-stimulation changes in swallowing. These changes fell outside the swallow-to-swallow variability derived from the comparative data
Post-stimulation changes were observed for pharyngeal transit time (PTT), total number of swallows (TNS), and penetration-aspiration score (PAS)
Summary
Oncologic interventions for head and neck cancer may include radiation, chemotherapy, surgical removal of affected tissues, or some combination of these. As such, these patients are at risk for developing dysphagia and subsequent malnutrition and aspiration pneumonia. Hamdy et al applied electrical stimulation to the pharyngeal muscles of healthy participants and found changes in cortical excitability, measured by transcranial magnetic stimulation (TMS) [3]. They noted an increase in motor cortex excitability in the cortical area representing the pharynx [3]. Electrical stimulation of the pharyngeal wall may provide benefit to other populations with dysphagia, such as patients treated for head and neck cancer
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